Wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical results of wedge osteotomy and subtalar arthrodesis for rockbottom malunion after calcaneal fracture.Methods From February 2014 to February 2015,9 cases of rockbottom malunion after calcaneal fracture were treated with wedged osteotomy and subtalar arthrodesis.They were 8 men and one woman,aged from 31 to 49 years (average,40.5 years).Weight-bearing X-rays were taken before surgery and at final follow-ups.Talar declination,lateral talocalcaneal angle,lateral talo-first metatarsal angle and B(o)hler's angle were used to evaluate correction of the malunion.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS) for pain were used to assess functional recovery.Results Eight of them were fully followed up for an average time of 30.6 months (from 27 to 38 months).All the osteotomy sites and subtalar joints obtained bony union after an average of 17.1 weeks (from 12 to 22 weeks).The talar declination was improved from 2.5° (from-6° to 13°) preoperatively to 13.2° (from 5° to 19°) postoperatively,the lateral talocalcaneal angle from-0.2° (from-15° to 10°) preoperatively to 20.2° (from 7° to 25°) postoperatively,the talo-first metatarsal angle from 21.1° (from 10° to 30°) preoperatively to 9.9° (from 5° to 14°) postoperatively,and the calcaneal B(o)hler' s angle from-25.6° (from-39° to-10°) preoperatively to 22.4° (from 10° to 35°) postoperatively.The AOFAS score averaged 26.6° (from 12 to 53) preoperatively and 79.7 (from 72 to 89) at the final follow-up;the VAS score averaged 7.5 (from 6 to 9) preoperatively and 2.6 (from 2 to 3) at the final follow-up.Both scores demonstrated improvements after operation.Conclusions Since the pathoanatomy of rockbottom malunion after calcaneal fracture consist in severe loss of calcaneal height,resulting in horizontalization of the talus and anterior ankle impingement,wedge osteotomy and sutalar arthrodesis can effectively correct the malunion,restore the loss of calcaneal height and hindfoot malalignment,and relieve the symptoms.