Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

Abstract

Hindfoot malunions after fractures of the talus and calcaneus lead to severe disability and pain. Corrective osteotomies and arthrodeses aim at functional rehabilitation and reduction of pain resulting from post-traumatic arthritis, eccentric loading and impingement due to hindfoot malunion. Preoperative analysis should include the three-dimensional outline of the malunion, the presence of post-traumatic arthritis, non-union, or infection, the extent of any avascular necrosis or comorbidities. In properly selected, compliant patients with intact cartilage cover little or no, AVN, and adequate bone quality, a corrective joint-preserving osteotomy with secondary internal fixation may be carried out. In the majority of cases, realignment is augmented by arthrodesis for post-traumatic arthritis. Fusion is restricted to the affected joint(s) to minimise loss of function. Correction of the malunion is achieved by asymmetric joint resection, distraction and structural bone grafting with corrective osteotomies for severe axial malalignment. Bone grafting is also needed after resection of a fibrous non-union, sclerotic or necrotic bone. Numerous clinical studies have shown substantial functional improvement and high subjective satisfaction rates from pain reduction after corrective osteotomies and fusions for post-traumatic hindfoot malalignment. This article reviews the indications, techniques and results of corrective surgery after talar and calcaneal malunions and nonunions based on an easy-to-use classification.

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases

“…Mean Böhler angle rose from 6.9°pre-operatively to 30°postoperatively and did not vary during the follow-up, which is proof of reduction stability. The rear-foot axis was restored in all cases, which confirmed the efficacy of the distractor and prevented severe disability and pain [18]. Secondary displacement was observed in one patient who decided to walk with full weight bearing in the immediate postoperative days.…”

Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures

“…Nonoperative treatment of DIACFs is unlikely to result in normal function because of secondary arthritis requiring fusion and malunion of the calcaneus leading to a painful foot deformity. 1,11,12,24,26,[27][28][29][30] When performing open reduction and internal fixation of DIACFs, anatomic reduction of overall shape of the calcaneus and meticulous restoration of subtalar joint congruity is prerequisites for reliable long-term results. [3][4][5][6][7]11,26 The most widely used extended lateral approach allows adequate exposure for anatomic reduction of the posterior, medial, and cuboidal facet, restoration of the lateral wall, and application of a locking or nonlocking plate.…”

Peroneal Tendon Instability in Intra-Articular Calcaneus Fractures

“…19,20 As was performed in this study, we prefer to carry the lateral flap dissection anteriorly over the posterolateral fibula. This requires working through the extensile lateral approach to the calcaneus to gain access to the superior peroneal retinaculum and tendon sheath.…”