The Case for “Save as Many Joints as Possible”—The “SamJap” Approach

Although early researchers had cautioned against isolated talonavicular arthrodesisTalonavicular arthrodesis in Müller-Weiss diseaseMüller-Weiss disease, there is a trend reversal towards preserving the naviculocuneiform (NC), calcaneocuboid and subtalar joints wherever possible. Some centers perform in-situ talonavicular or triple arthrodesisTriple arthrodesis without attempt at reducing medial talonavicular subluxationTalonavicular subluxation. Others effect reduction utilizing a lateral tension bandLateral tension band principle or a pin distractor to derotate the plantar and medially displaced navicularNavicular lateralwards and dorsalwards to its normal location, and perform isolated talonavicular arthrodesis leaving the NC joints untouched unless they are severely affected. An interesting albeit perhaps unconventional 4-joint arthrodesis4-joint arthrodesis consists of a standard triple plus tricortical iliac crest bone graft interposed between the talar head and lateral cuneiform bone. The non-diseased NC1 and NC2 are left untouched. Several authors have also noted disease, often asymptomatic, at NC3 with healthy NC1 and NC2 joints, and have proceeded to isolated talonavicular or triple arthrodesis leaving the NC joints out of the fusion mass.