Early Tibiocalcaneal Fusion in the Treatment of Severe Injuries of the Talus

Reckling, Frederick W.

doi:10.1097/00005373-197205000-00010

Cited by 48 publications

(29 citation statements)

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“…4,21,22 Most authors suggest salvage treatment by arthrodesis. [4][5][6][7][8]23 Vascularised bone flaps have become an important part of foot and ankle surgery. [9][10][11][12]18,24 In suitable circumstances, a vascularised bone graft can reverse AVN of the talus and avoid progressive collapse.…”

Section: Discussionmentioning

confidence: 99%

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle

Kodama

Takemura

Ueba

et al. 2015

The Bone & Joint Journal

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A new method of vascularised tibial grafting has been developed for the treatment of avascular necrosis (AVN) of the talus and secondary osteoarthritis (OA) of the ankle. We used 40 cadavers to identify the vascular anatomy of the distal tibia in order to establish how to elevate a vascularised tibial graft safely. Between 2008 and 2012, eight patients (three male, five female, mean age 50 years; 26 to 68) with isolated AVN of the talus and 12 patients (four male, eight female, mean age 58 years; 23 to 76) with secondary OA underwent vascularised bone grafting from the distal tibia either to revascularise the talus or for arthrodesis. The radiological and clinical outcomes were evaluated at a mean follow-up of 31 months (24 to 62). The peri-malleolar arterial arch was confirmed in the cadaveric study. A vascularised bone graft could be elevated safely using the peri-malleolar pedicle. The clinical outcomes for the group with AVN of the talus assessed with the mean Mazur ankle grading scores, improved significantly from 39 points (21 to 48) pre-operatively to 81 points (73 to 90) at the final follow-up (p = 0.01). In all eight revascularisations, bone healing was obtained without progression to talar collapse, and union was established in 11 of 12 vascularised arthrodeses at a mean follow-up of 34 months (24 to 58). MRI showed revascularisation of the talus in all patients. We conclude that a vascularised tibial graft can be used both for revascularisation of the talus and for the arthrodesis of the ankle in patients with OA secondary to AVN of the talus.

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Section: Discussionmentioning

confidence: 99%

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle

Kodama

Takemura

Ueba

et al. 2015

The Bone & Joint Journal

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“…1 This was combined in patients below the age of 60 years with a proximal tibial corticotomy and callotasis distraction to correct the shortening which resulted from the talar resection. Trauma was the cause of the avascular necrosis in five patients; the sixth had a failed primary ankle arthrodesis complicated by avascular necrosis of the talus (Table I).…”

Section: Methodsmentioning

confidence: 99%

“…Tibiocalcaneal fusion, as described by Reckling, 1 gives the best functional result, but at the expense of shortening.…”

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confidence: 99%

Tibiocalcaneal fusion for avascular necrosis of the talus

Dennison

Pool

Simonis

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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Between 1994 and 1999, we treated six patients with avascular necrosis of the talus by excision of the necrotic body of the talus and tibiocalcaneal fusion using an Ilizarov frame. This was combined with corticotomy and a lengthening procedure. Shortening was corrected in all patients except two, who were over 60 years of age.All patients had previous operations which had failed. All achieved solid bony fusion, with five out of six having either a good or an excellent result.We conclude that this is an effective reconstructive technique which gives a good functional result. [Br] 2001;83-B:199-203. J Bone Joint Surg Received 28 June 2000; Accepted 4 August 2000It is not possible to predict with certainty the degree of avascular necrosis which may occur after a fracture of the talus, or the severity of symptoms which will result from such an injury. Immediately after the fracture every attempt should be made to preserve the talus. If avascular necrosis occurs the results are usually disabling. We could find no published review of the types of surgery carried out at this stage. The surgical options include talectomy, tibiotalar arthrodesis, pantalar arthrodesis, tibiocalcaneal arthrodesis, or below-knee amputation. All of these procedures produce long-term problems.Tibiocalcaneal fusion, as described by Reckling, 1 gives the best functional result, but at the expense of shortening. We have used a modification of his technique, using an Ilizarov frame to compress the arthrodesis while, at the same time, lengthening the leg at an upper tibial corticotomy. For patients over the age of 60 years we have accepted the shortening produced by the surgery and not attempted to lengthen the leg because this extra surgical procedure increases the complications. Patients and MethodsBetween 1994 and 1999 we carried out six unilateral tibiocalcaneal fusions for avascular necrosis of the talus, using a modification of the method originally described by Reckling. 1 This was combined in patients below the age of 60 years with a proximal tibial corticotomy and callotasis distraction to correct the shortening which resulted from the talar resection. Trauma was the cause of the avascular necrosis in five patients; the sixth had a failed primary ankle arthrodesis complicated by avascular necrosis of the talus (Table I). Their mean age was 45 years (27 to 67), and the mean number of previous operative procedures for each ankle was five (1 to 16). The mean delay from the initial injury to the time of operation for tibiocalcaneal fusion was 56 months (2 to 231).The distal fibula was excised using a lateral incision and the peroneii and extensor digitorum longus divided in a Z fashion between sutures. A medial incision allowed the necrotic body of the talus to be excised and the ankle to be dislocated medially to expose the distal tibia. Cuts were made with an oscillating saw in transverse and coronal planes as shown by the dotted line in Figure 1, with resection to healthy bleeding bone. The cut surfaces between the tibia and calcaneus were...

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“…14 Moreover, patients may be more mobile and have better function after a tibiocalcaneal arthrodesis than after a pantalar arthrodesis. [17][18][19][20][21][22][23][24] After a total talectomy in adults, there is no specific literature on whether the tibionavicular articulation should be included within the fusion mass of the hindfoot.…”

Section: Historical Perspectivementioning

confidence: 99%

Talectomy and Tibiocalcaneal Arthrodesis in Adult Complex Hindfoot Reconstruction

Guha

Singh

Zaidi

et al. 2013

Techniques in Foot &Amp; Ankle Surgery

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Single-stage total talectomy with tibiocalcaneal arthrodesis can restore excellent function in adult patients with severe rigid, unbraceable hindfoot deformities. Talectomy allows adequate soft tissue decompression and correction of bony malalignment, restoring stability to the hindfoot axis on weight bearing. We performed singlestage total talectomy with tibiocalcaneal arthrodesis on 13 feet in 12 patients (6F; 6M) with an average age of 67 years (range, 54 to 77 y). Fusion was achieved in 9 feet (69%) at an average time of 21 weeks. In the remaining 4 feet, in which consolidation of the fusion was not achieved, the deformity remained corrected and this allowed the patients to mobilize in braces. Average duration of follow-up was 21 months (range, 12 to 52 mo). All patients had a stable, plantigrade, braceable foot and were community or household ambulators. Our data suggests that this procedure should be added to the armamentarium of procedures to salvage severe hindfoot deformities.

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Early Tibiocalcaneal Fusion in the Treatment of Severe Injuries of the Talus

Cited by 48 publications

References 0 publications

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle

A new form of surgical treatment for patients with avascular necrosis of the talus and secondary osteoarthritis of the ankle

Tibiocalcaneal fusion for avascular necrosis of the talus

Talectomy and Tibiocalcaneal Arthrodesis in Adult Complex Hindfoot Reconstruction

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