1
|
Li M, Liu H, Xu C. A comparison of outcomes of posterior arthroscopic subtalar arthrodesis with or without bone graft for treatment of subtalar arthritis. Foot Ankle Surg 2022; 28:1452-1457. [PMID: 36041988 DOI: 10.1016/j.fas.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It remains unclear whether to perform a bone graft is necessary during posterior arthroscopic subtalar arthrodesis. The present research aimed to comparatively analyze the outcomes of arthroscopic subtalar arthrodesis through a 3-portal posterior approach with or without bone graft. METHODS A total of 93 patients with subtalar arthritis who underwent posterior arthroscopic subtalar arthrodesis were retrospectively examined. The patients were divided into two groups according to whether they received bone graft or not. The clinical outcomes were compared for analysis. RESULTS Among the 93 patients included, 53 received bone graft and 40 did not. The union rate and time to osseous fusion suggested no significant difference between the two groups. The improvement of clinical outcomes were comparable between the two groups at the final follow-up. CONCLUSIONS In the present study, bone graft could not effectively reduce the risk of nonunion and improve the outcome.
Collapse
Affiliation(s)
- Mingqing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China.
| |
Collapse
|
2
|
Vilá-Rico J, Ojeda-Thies C, Mellado-Romero MÁ, Sánchez-Morata EJ, Ramos-Pascua LR. Arthroscopic posterior subtalar arthrodesis for salvage of posttraumatic arthritis following calcaneal fractures. Injury 2018; 49 Suppl 2:S65-S70. [PMID: 30219150 DOI: 10.1016/j.injury.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subtalar arthrodesis is a treatment option for pain due to posttraumatic arthritis following calcaneal fractures. The goal of this study is to examine the results of arthroscopic subtalar arthrodesis for posttraumatic arthritis following calcaneal fractures. PATIENTS AND METHODS We performed a retrospective case series reviewing 37 consecutive patients (36 male) treated for posttraumatic arthritis following calcaneal fractures by arthroscopic subtalar arthrodesis. The fractures were due to high-energy injuries in 81% of cases, and 12 fractures (32.4%) had been previously treated with internal fixation. Average follow-up was 57.5 months. RESULTS Average American Orthopedic Foot and Ankle Society (AOFAS) scores significantly improved from 49.0 ± 10.9 points preoperatively to 76.0 ± 8.0 points at final follow-up. Average time to union was 12.5 weeks. Six patients (16.2%) suffered complications: superficial wound infection (2.7%), symptomatic hardware that warranted removal (5.4%) and nonunion (8.1%) presented nonunion. All three cases had prior internal fixation through an extensile lateral approach, and fused after a repeat surgery. CONCLUSION Arthroscopic subtalar arthrodesis offers consistent improvement in cases of posttraumatic arthritis following calcaneal fractures, with a union rate similar to published series of open arthrodesis. We observed more nonunions in patients who had been treated previously with internal fixation. In spite of this, we continue to recommend arthroscopic subtalar arthrodesis, as it preserves the soft tissue envelope better than open techniques.
Collapse
Affiliation(s)
- Jesús Vilá-Rico
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
3
|
Park J, Chung WY. Osteochondral allograft reconstruction of talar body fracture with a large bone defect. Arch Orthop Trauma Surg 2016; 136:35-40. [PMID: 26476722 DOI: 10.1007/s00402-015-2347-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Indexed: 11/26/2022]
Abstract
Talar body fractures are rare and associated with a high rate of morbidity due to poor vascularity and the frequent occurrence of posttraumatic osteoarthritis. If talar body fractures are combined with a large bone defect, the situation becomes even more challenging due to difficult joint reconstruction. Only few reports have described the use of whole-bone fresh-frozen allografts for the treatment of foot trauma. Osteochondral bulk allografts can be used as an alternative to tibiotalar arthrodesis for the treatment of talar body fractures with large bone defects, especially in young patients. Here, we report a case of a talar body fracture associated with a large talar bone defect involving the posterior process that was treated by fresh-frozen osteochondral allograft for tibiotalar reconstruction in foot injuries.
Collapse
|
4
|
Roster B, Kreulen C, Giza E. Subtalar joint arthrodesis: open and arthroscopic indications and surgical techniques. Foot Ankle Clin 2015; 20:319-34. [PMID: 26043247 DOI: 10.1016/j.fcl.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthrodesis of the subtalar joint can be performed via both open and arthroscopic techniques. Both groups of procedures have their own relative indications and contraindications, as well as complications. Good results have been reported for both general procedures, although some studies suggest superiority with arthroscopic subtalar arthrodesis.
Collapse
Affiliation(s)
- Brent Roster
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
| | - Christopher Kreulen
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Eric Giza
- UC Davis Medical Center, Sacramento, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| |
Collapse
|
5
|
Holm JL, Laxson SE, Schuberth JM. Primary subtalar joint arthrodesis for comminuted fractures of the calcaneus. J Foot Ankle Surg 2014; 54:61-5. [PMID: 25176004 DOI: 10.1053/j.jfas.2014.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Indexed: 02/03/2023]
Abstract
Severely comminuted intra-articular calcaneal fractures often culminate in subtalar arthrosis and stiffness even after operative reduction. In some instances, subtalar arthrodesis is necessary to reduce the symptoms. Primary subtalar arthrodesis for these fractures has gained acceptance in recent years. However, few definite predictors of functional outcome after primary fusion have been found. A series of 17 patients with highly comminuted fractures were studied to determine which radiographic parameters were predictive of functional outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score was obtained at an average of 34 (range 12 to 157) months after arthrodesis. Radiographic measurements included the talocalcaneal, calcaneal inclination, talo-first metatarsal, and Böhler's angles, and the height of the tibial plafond, width of the calcaneus, and the presence of a medial step-off on the injured and uninjured foot. The mean Ankle-Hindfoot scale score was 78 (range 56 to 92), and the mean visual analog score was 1.9 (0 to 4). Statistically significant associations were noted between greater postoperative function and increasing age (p = .028), the quality of restoration of Böhler's angle (p = .038), and the talocalcaneal angle (p = .049). No patient had nonunion. The results of the present study suggest that the outcomes after primary arthrodesis of the subtalar joint are favorable, in particular, when the radiographic relationships of the hindfoot have been restored.
Collapse
Affiliation(s)
- Janson L Holm
- Staff Foot and Ankle Surgeon, Department of Podiatric Surgery, The Portland Clinic, Portland, OR
| | - Steven E Laxson
- Staff Foot and Ankle Surgeon, Department of Podiatric Surgery, Kaiser Permanente, Northwest, PC, Portland, OR
| | - John M Schuberth
- Chief, Foot and Ankle Surgery, Department of Orthopedic Surgery, Kaiser Foundation Hospital, San Francisco, CA.
| |
Collapse
|
6
|
Yu GR, Hu SJ, Yang YF, Zhao HM, Zhang SM. Reconstruction of calcaneal fracture malunion with osteotomy and subtalar joint salvage: technique and outcomes. Foot Ankle Int 2013; 34:726-33. [PMID: 23460670 DOI: 10.1177/1071100713479766] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. METHODS From May 2005 to November 2008, 24 patients (26 feet) with calcaneal malunions after a displaced intra-articular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 5.7 months (95% confidence interval, 4.5-8.8 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the exostosis that had been removed; iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Twenty patients (21 feet) were followed for a mean of 34.2 months (29.0-39.4 months). RESULTS According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 85.9 points (95% confidence interval, 81.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler's angle, Gissane's angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Six patients had wound edge necrosis, and 2 had superficial infection. One patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. CONCLUSIONS Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Guang-Rong Yu
- Orthopaedic Surgery Department, Tongji Hospital of Tongji University, Shanghai, China.
| | | | | | | | | |
Collapse
|
7
|
Abstract
Isolated subtalar arthrodesis is well accepted for treatment of pathologic conditions of the subtalar joint associated with pain, instability, and deformity that do not respond to conservative treatment. The most frequent indications are primary talocalcaneal or posttraumatic arthrosis; congenital malformations (coalition); or inflammatory diseases. In the last years, arthroscopic subtalar arthrodesis has become an established technique in treatment of the subtalar arthrosis in the absence of deformities, misalignment and bone loss. As this technique limits soft tissue damages, it may diminish hospitalization days. However, this technique necessitates basic experience in arthroscopy of small joints and knowledge of specific anatomy.
Collapse
Affiliation(s)
- Gerardo Muñoz Muraro
- Departamento de Traumatología, Clínica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile.
| | | |
Collapse
|
8
|
Molloy AP, Lipscombe SJ. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions. Foot Ankle Clin 2011; 16:165-79. [PMID: 21338937 DOI: 10.1016/j.fcl.2010.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Massive bone loss following calcaneal fractures is a challenging condition to treat, especially if nonunion is present. Meticulous preoperative examination and imaging are crucial for accurate preoperative planning. If performed, successful outcomes can be achieved with the strategies outlined in this article.
Collapse
Affiliation(s)
- Andy P Molloy
- Department of Orthopaedics and Trauma, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, United Kingdom.
| | | |
Collapse
|
9
|
Abstract
The potential for disabling malunion following calcaneal fracture is high, regardless whether a patient is treated nonsurgically or surgically. Fracture displacement typically results in loss of hindfoot height, varus heel position, and widening of the hindfoot, with possible subfibular impingement and irritation of the peroneal tendon and/or sural nerve. Frequently, the subtalar joint develops posttraumatic arthritis. In symptomatic patients with calcaneal malunion, systematic evaluation is required to determine the source of pain. Nonsurgical treatment, such as activity modification, bracing, orthoses, and injection, is effective in many patients. Surgical treatment may involve simple ostectomy, subtalar arthrodesis with or without distraction, or corrective calcaneal osteotomy. A high rate of successful arthrodesis and of patient satisfaction has been reported with surgical management.
Collapse
|
10
|
Bauer T, Deranlot J, Hardy P. Endoscopic treatment of calcaneo-fibular impingement. Knee Surg Sports Traumatol Arthrosc 2011; 19:131-6. [PMID: 20407751 DOI: 10.1007/s00167-010-1149-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/07/2010] [Indexed: 12/21/2022]
Abstract
The calcaneo-fibular impingement syndrome is frequent after calcaneal fracture and is linked to the decreased space between the tip of the fibula and the lateral wall of the calcaneus. The reasons for the painful symptoms are mixed with both bony and soft tissue involvement. The abnormal bony contact between the lateral calcaneal cortex and the tip of the fibula depends mainly on the size and localization of the lateral exostosis of the calcaneal wall. The soft tissue impingement is due to the fibrosis and scar tissues in the lateral gutter and to the compression of the peroneal tendons in the retromalleolar groove and under the tip of the malleolus. A 2-portal endoscopic technique is described for the treatment of calcaneo-fibular impingement with bone resection, soft tissue debridement and peroneal tendons release. One of the advantages of this endoscopic technique is the possibility of an assessment and treatment of associated lesions in the same procedure. A subtalar joint fusion can be done before if needed under arthroscopic control. As this endoscopic technique is very efficient to relieve symptoms of calcaneo-fibular impingement and is focused on the most relevant symptoms, it can thus be indicated for most of cases of calcaneal malunions, whatever the type of malunion and depending of the painful symptoms.
Collapse
Affiliation(s)
- T Bauer
- Department of Orthopaedic Surgery, Ambroise Paré Hospital, West Paris University, 9, avenue Charles de Gaulle, 92100 Boulogne, France.
| | | | | |
Collapse
|
11
|
Kanakaris NK, Mallina R, Calori GM, Kontakis G, Giannoudis PV. Use of bone morphogenetic proteins in arthrodesis: clinical results. Injury 2009; 40 Suppl 3:S62-6. [PMID: 20082794 DOI: 10.1016/s0020-1383(09)70014-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone grafting is not routinely required in primary arthrodesis in the absence of infection, avascular necrosis, bone defect or previous non-union; when any of the above factors is present, autograft is the gold-standard method. However, donor site morbidity and the quantitative and qualitative limitations of autograft have led to the development of alternatives. This study documents the use of the bone morphogenetic protein BMP-7 in a total of 19 joint fusions (ankle, subtalar, talonavicular, pubic and sacroiliac). Healing rates of 90% and satisfactory subjective functional outcome in 70% of cases were recorded over a minimum follow-up of 15 months. These data should provide a sound foundation for future clinical trials evaluating the application of BMP-7 in the fusion of joints.
Collapse
Affiliation(s)
- Nikolaos K Kanakaris
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds LS1 3EX, UK
| | | | | | | | | |
Collapse
|
12
|
Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg 2009; 48:315-22. [PMID: 19423031 DOI: 10.1053/j.jfas.2009.01.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED A retrospective analysis of 24 cases of minimally invasive, open reduction, and internal fixation of intra-articular calcaneal fractures is presented. Collected data included articular step-off, medial wall displacement, and Boehler's angle, in addition to other descriptive characteristics of the fracture and case series. The operative technique is described in detail including the optimal screw constructs. Arthroscopic assistance was used in 10 of the cases. The articular step-off of the posterior facet, medial wall displacement, and Boehler's angle all displayed statistically significant change between the preoperative and postoperative periods (P < .0001). These results were consistent with the goal of restoration of articular congruity, calcaneal morphology, and calcaneal height. There were no soft tissue complications. The mean overall follow-up duration was 2.8 years (range 1 to 10 years). Of the 18 patients who were followed for more than 1 year (range 1.0 to 10 years), none went on to subtalar fusion. The results of this study suggest that a minimally invasive approach can improve radiographic parameters consistent with the ultimate goals of operative reduction of calcaneal fractures, and can be used to achieve satisfactory results with minimal risk of wound complication. LEVEL OF CLINICAL EVIDENCE 4.
Collapse
Affiliation(s)
- John M Schuberth
- Foot and Ankle Surgery, Department of Orthopaedic Surgery, Kaiser Foundation Hospital, 450 6th Avenue, San Francisco, CA 94118, USA.
| | | | | |
Collapse
|
13
|
Savva N, Saxby TS. In situ arthrodesis with lateral-wall ostectomy for the sequelae of fracture of the os calcis. ACTA ACUST UNITED AC 2007; 89:919-24. [PMID: 17673586 DOI: 10.1302/0301-620x.89b7.18926] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Distraction bone-block arthrodesis has been advocated for the treatment of the late sequelae of fracture of the os calcis. Between 1997 and 2003 we studied a consecutive series of 17 patients who had in situ arthrodesis for subtalar arthritis after fracture of the os calcis with marked loss of talocalcaneal height. None had undergone any previous attempts at reconstruction. We assessed the range of dorsiflexion and plantar flexion and measured the talocalcaneal height, talocalcaneal angle and talar declination angle on standing lateral radiographs, comparing them with the normal foot. The mean follow-up was for 78.7 months (48 to 94). The mean American Orthopaedic Foot and Ankle Society hindfoot score improved from 29.8 (13 to 48) to 77.8 (48 to 94) (Student's t-test, p < 0.001). The mean loss of talocalcaneal height was 10.3 mm (2 to 17) and the mean talar declination angle was 6.7 degrees (0 degrees to 16 degrees) which was 36% of the normal side. One patient suffered anterior ankle pain but none had anterior impingement. Two patients complained of difficulty in ascending slopes and stairs and four in descending. The mean ankle dorsiflexion on the arthrodesed side was 11.6 degrees (0 degrees to 24 degrees) compared with 14.7 degrees (0 degrees to 24 degrees) on the normal side, representing a reduction of 21.1%. The mean plantar flexion on the arthrodesed side was 35.5 degrees (24 degrees to 60 degrees) compared with 44.6 degrees (30 degrees to 60 degrees ) on the normal side, a reduction of 20.4%. These results suggest that anterior impingement need not to be a significant problem after subtalar arthrodesis for fracture of the os calcis, even when the loss of talocalcaneal height is marked. We recommend in situ arthrodesis combined with lateral-wall ostectomy for all cases of subtalar arthritis following a fracture of the os calcis, without marked coronal deformity, regardless of the degree of talocalcaneal height loss.
Collapse
Affiliation(s)
- N Savva
- Brisbane Foot and Ankle Centre, 259 Wickham Terrace, Brisbane 4000, Australia
| | | |
Collapse
|
14
|
Abstract
This article outlines the pathoanatomy of malunited calcaneal fractures and reviews the literature on resulting painful sequelae, diagnostic work-up, as well as reconstructive treatment options and their outcome.
Collapse
Affiliation(s)
- Florian Nickisch
- OrthoCarolina, PA, 1001 Blythe Boulevard, Suite 200, Charlotte, NC 28203, USA
| | | |
Collapse
|
15
|
Rubel IF, Carrer A. Fresh-frozen osteochondral allograft reconstruction of a severely fractured talus. A case report. J Bone Joint Surg Am 2005; 87:625-9. [PMID: 15741633 DOI: 10.2106/jbjs.c.01671] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ivan F Rubel
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY 11203, USA
| | | |
Collapse
|