Mid-Term Follow Up Results of Subtalar Distraction Arthrodesis Using a Double Bone-Block for Calcaneal Malunion

PURPOSE: This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. MATERIALS AND METHODS: From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. RESULTS: The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8degrees in talocalcaneal angle, 5.1degrees in talar declination angle and 5.3degrees in talo-first metatarsal angle. CONCLUSION: Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.

Subtalar Distraction Arthrodesis Using Frozen Allobone Graft by Interpositional Structural / 대한족부족관절학회지

PURPOSE: Subtalar distraction arthrodesis is useful treatment option for restore hindfoot alignment. but, using structural autograft have high risk of donor site morbidity. Recently, by replacing the structural allograft has been reported satisfactory clinical results. Therefore, the authors reviewed the results of subtalar distraction arthrodesis using a structural allograft, retrospectively. MATERIALS AND METHODS: From January 2008 to May 2010, 12 patients (12 feets; 9 male, 3 female) underwent subtalar distraction arthrodesis using frozen structural allograft. 9 cases were calcaneal malunion, 2 were nonunion or malunion after subtalar arthrodesis, 1 was other cause. Mean age was 38.9 (12~66) years old and follow up period was 16.5 (12~36) months. Surgical was performed with posterolateral approach and tricortical allobone block of frozen femoral neck was used. Analysis was done with retorspective manner to evaluate preoperative, postoperative, and final follow up radiologic measurement and AOFAS ankle-hindfoot scale. RESULTS: There was statistically significant increase (p<0.05) of ankle-hindfoot scale from preoperative 27.5 points to postoperative 72.5 points, talocalcaneal height by 6.62 mm, calcaneal pitch angle by 5.73 degrees, lateral talocalcaneal angle by 6.38 degrees and significant decrease (p<0.05) of tali-1st metatarsal angle by 5.23 degrees. 11 feet (91.7%) acquired bony union and it takes average 5.1 months. Final post-operative result revealed talocalcaneal height changed by 2.57 mm, calcaneal pitch anble, lateral talocalcaneal angle, talar-1st metatarsal angle were changed by 2.63 degrees, 1.62 degrees, 1.18 degrees, respectively (p<0.05). 3 cases of partial osteonecrosis of posterior facet of calcaneus were observed in operation field, 4 cases of complication were developed (1 case of nonunion, 1 collapse of allobone graft, 1 screw loosening, 1 superficial skin necrosis). CONCLUSION: Subtalar distraction arthrodesis using frozen structural allobone graft is useful alternative treatment method of arthrodesis with structural autobone graft.

Subtalar Distraction Arthrodesis for Calcaneal Malunion

PURPOSE: To evaluate the results and efficacy of the subtalar distraction arthrodesis on patients with complications due to malunion after intra-articular calcaneal fracture. MATERIALS AND METHODS: From October 2001 to September 2004, we operated on 10 patients (14 cases). There were 9 male patients and one female; their mean age was 41 years old. Ten cases among them were operated initially. The mean period between initial injury and arthrodesis was 18 months. The mean follow up period was 16 months. During the operation, we used extensile lateral approach and arthrodesis was performed using tricortical bone block and cannulated screws. The ankle-hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT of the both feet were examined for union and various parameters. RESULTS: Thriteen cases achieved radiologic bone union. The mean ankle-hindfoot scale (maximum: 94 points) increased from 52.4 points preoperatively to points 77.2 at the final follow-up. The radiologic analysis of the pre and postoperative standing lateral radiograph showed mean increase of 6.9 mm in talo-calcaneal height, 5.2 degrees in talocalcaneal angle, 4.3 degrees in talar declination angle and average decrease of 4.5 degrees in talo-first metatarsal angle. CONCLUSION: The short term result of the subtalar distraction arthrodesis using tricortical bone block was promising, but longer follow-up will be needed.