Subtalar distraction bone block arthrodesis

Abstract

This retrospective study analyses the results of subtalar bone block distraction arthrodesis used in the treatment of late complications of calcaneal fractures, acute severely comminuted fractures, nonunion (and malunion) of attempted subtalar arthrodeses, avascular necrosis of the talus, and club-foot deformity. Of 39 patients (41 feet) who had this procedure, 35 (37 feet) returned for follow-up after a mean of 70 months (26 to 140). There were 24 men (25 feet) and 11 women (12 feet) with a mean age of 41 years (16 to 63). Each completed a standardised questionnaire, based on the hindfoot-scoring system of the American Orthopaedic Foot and Ankle Society and were reviewed both clinically and radiologically. Of the 37 operations, 32 (87%) achieved union. The mean hindfoot score (maximum of 94 points) increased from 21.1 points (8 to 46) preoperatively to 68.9 (14 to 82) at the final follow-up. The mean talocalcaneal and calcaneal pitch angles were 20.5 degrees and 4.9 degrees before operation, 25.9 degrees and 8.3 degrees immediately after, and 24.6 degrees and 7.7 degrees at the final follow-up, respectively. The mean talar declination angle improved from 6.5 degrees (-10 to 22) before operation to 24.8 degrees (14 to 32) at the final follow-up. The mean talocalcaneal height increased from 68.7 mm before operation to 74.5 mm immediately after and 73.5 mm at the final follow-up. Of the 37 arthrodeses available for review, 32 were successful; 29 patients (30 arthrodeses) were satisfied with the procedure. Minimal loss of hindfoot alignment occurred when comparing radiographs taken immediately after operation and at final follow-up.

Can Porous Tantalum Be Used to Achieve Ankle and Subtalar Arthrodesis?: A Pilot Study

“…For this pilot study, a block of tantalum was used instead. Other studies using structural grafts in foot surgery are limited to autograft from the fibula or iliac crest with a union rate of 87% to 100% (Table 3) [1,7,14,31,32,39,50]. Donor-site morbidity was not reported in these studies, but we presume the rates would be similar to those reported for spinal surgery.…”

“…To achieve and maintain a desired correction, a structural graft often is needed to fill gaps during reconstructive procedures of the ankle and hindfoot (eg, in subtalar distraction arthrodesis, fusion after failed total ankle arthroplasty, lateral column lengthening) [50,58]. Recognized options currently include autograft, allograft, and xenograft bone, each associated with certain disadvantages.…”

Computer based systems in foot and ankle surgery at the beginning of the 21st century

“…The biomechanical consequences of these deformities frequently lead to clinical symptoms like pain and gait disturbances [2,12,33,39,42,53,58,65,68,71]. The correction of the deformities is challenging [5,67,71]. The preoperative diagnostic with radiographs and CT allows accurate planning of the correction even with computerized planning systems [13].…”

The value of Weight-Bearing CT scan in the evaluation of subtalar distraction bone block arthrodesis: Case report

“…The latter may result in painful calcaneofibular abutment and peroneal tendon pathology, commonly dislocation, tears or tendinopathy. Other causes of subtalar depression include erosive primary subtalar osteoarthritis, nonunion or malunion of attempted subtalar arthrodesis and talar avascular necrosis [3].…”