Subtalar Distraction Osteogenesis for Posttraumatic Arthritis Following Intra-Articular Calcaneal Fractures

Fan, Weili; Sun, Hansong; Wu, Siyu; Wang, Aimin

doi:10.1177/1071100712472039

Cited by 9 publications

(5 citation statements)

References 11 publications

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“…In case of absolute bone loss or extensive fragmentation and vascular impairment, distraction osteogenesis or vascularized bone transfers usually yield better results than does conventional cancellous bone grafting. 1,8,36 Fan and et al 8 reported good functional long-term outcomes in calcaneal reconstruction with distraction osteogenesis. Nonetheless, distraction osteogenesis is used only occasionally in Skin sensation in the plantar part of the foot cancellous small bone defects and has the problem of pin site infection.…”

Section: Discussionmentioning

confidence: 98%

“…[2][3][4][5][6][7] Although distraction osteogenesis is seldom used to treat cancellous bone defects of the distal tibia or of the cuboid, navicular, and talar bones of the hind foot, it has served in the treatment of calcaneal defects. 8 Furthermore, an extensive soft tissue defect may preclude local flap options and thus require free soft-tissue flap reconstruction. 9,10 Vascularized bone transfers encourage revascularization and provide conditions conductive to bone healing.…”

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confidence: 99%

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Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

Repo

Barner-Rasmussen

Roine

et al. 2016

J reconstr Microsurg

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Background Reconstruction of extensive bone and compound defects in the foot and ankle is challenging. This cross-sectional study aimed to assess the outcomes of free iliac crest flap in foot and ankle reconstruction. Methods We retrospectively reviewed patient records and identified 13 cases with 1 osseous and 12 composite free iliac crest grafts for compound fracture (n = 3) or sequelae (n = 10) in the foot and ankle. We applied the visual analogue scale foot and ankle, the Oswestry disability index, and the 15D health-related quality of life (HRQoL) instruments. Results The average follow-up period was 3.9 years (range, 1.3-8.0 years). Four patients underwent early reoperations; venous and arterial reanastomosis (n = 1), minor wound revision (n = 2), or flap reconstruction due to partial necrosis of the skin island (n = 1). The median time to bone union was 23 months (range, 7-46 months). One permanent pseudoarthrosis occurred. One patient underwent late below-knee amputation due to chronic pain and functional impairment. One patient required flap reconstruction due to a late donor-site defect. Seven patients completed the questionnaires on an average of 14.7 years postoperatively (range, 2.0-26.9 years). Noted impairment of the donor site and of the reconstructed limb ranged from none to significant. Five (out of seven) patients had a HRQoL comparable to that of an age-standardized general population. Conclusions The free iliac crest flap is a feasible option for extensive compound fractures and bone-healing complications in the foot and ankle. It can also be used to achieve ankle arthrodesis when other techniques have failed and in patients at high risk for amputation.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

Repo

Barner-Rasmussen

Roine

et al. 2016

J reconstr Microsurg

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“…Inappropriately treated displaced calcaneal fracturealways leads to altered calcaneal morphology, including loss of height, heel widening, subfibular impingement, calcaneocuboid joint impingement, varus heel and subtalar joint incongruence, which further causes pain localized to the lateral, anterior, plantar or/and medial foot. Some studies have provided insight into the pain mechanics and reached a consensus on the diagnosis of localization: (i) lateral pain may be the result of peroneal tendon problems, subtalar arthrosis, calcaneocuboid arthrosis, symptomatic hardware, and/or sural nerve problems; (ii) pain localized to the anterior ankle is most commonly caused by anterior impingement of the talar neck on the distal tibia resulting from loss of the calcaneal height; (iii) plantar foot pain or heel pain may result from plantar exostosis or from injury to the heel pad; and (iv) medial pain may be the result of tarsal tunnel syndrome or flexor hallucis longus (FHL) tendon problems 14–17 . Thus, it is the disrupted anatomical relationship of the calcaneus that results in various symptoms following malunited calcaneal fractures, and the goal of surgical management is to restore physical anatomy to maximize the function and lifespan of the joint.…”

Section: Discussionmentioning

confidence: 99%

Multiple Reconstructive Osteotomy Treating Malunited Calcaneal Fractures Without Subtalar Joint Fusion

Wang

Guan

et al. 2023

Orthopaedic Surgery

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Objective Various surgical techniques have been reported in treating calcaneal malunions over the decades, while the operations on single plane were accompanied by respective limitations. The purpose of this study is to evaluate the efficacy of a novel multiple reconstructive osteotomy for treating malunited calcaneal fractures without subtalar joint fusion. Methods From March 12, 2010, to August 17, 2017, 10 patients (10 feet) with malunited calcaneal fractures were treated with multiple reconstructive osteotomy with subtalar joint‐preserving operations. All patients were treated with a corrective osteotomy, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 5.6 ± 2.41 months since the initial injury. With the utilization of the multiple reconstructive osteotomy, the posterior facet was restored to preserve the subtalar joint. All patients were evaluated clinically and radiographically at a mean follow‐up of 3.04 ± 1.21 years. Results All patients were subjectively satisfied with the treatment. The average time to union was 12.2 ± 1.11 weeks. The American Orthopedic Foot and Ankle (AOFAS) ankle and hind foot score was 86.3 ± 4.45 (t = 27.64, P < 0.0001, paired t‐test), which was significantly higher than the preoperative assessment. Postoperative radiographic assessment revealed great improvement in Böhler's angle (from 25.4° to 86.3°), talocalcaneal height (65.15–72.68 mm) and Calcaneus‐talus angle (from 34.46° to 39.7°). One patient had mild discomfort after a 1‐h brisk walk. One patient was suspected to have early posttraumatic arthritis of the subtalar joint based upon radiographic evidence during the follow‐up, but the patients could walk normally for a long time without pain. Conclusion Multiple reconstructive osteotomy is an effective way to restore the calcaneal morphology and preserve the subtalar joint for selected calcaneal malunion.

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“…We read with great interest your recent publication of the article by Fan et al 2 In their retrospective study, they used external fixator to fix the subtalar joint following remove of the articular surface and subchondral bone of the posterior subtalar facet. And they concluded that this method was novel and effective for posttraumatic subtalar arthritis following intra-articular calcaneal fractures.…”

Section: Dear Editormentioning

confidence: 99%

“…First, although subtalar distraction osteogenesis with spanning external fixation could provide good clinical results, there are some disadvantages with the external fixation. 2 With external fixator spanning ankle and subtalar joints, the ankle joint space could be more easily widened rather than subtalar joint, thus leading to potential injury of the ankle joint. 3 Removal of the external fixator after bone fusion at an average of 4.9 months (range, 4-8 months) could result in the ankle stiffness.…”

Section: Dear Editormentioning

confidence: 99%