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Lerch RJ, Gulati A, Highlander PD. Revision of Subtalar Joint Arthrodesis: Considerations for Bone Grafting, Fixation Constructs, and Three-Dimensional Printing. Clin Podiatr Med Surg 2023; 40:633-648. [PMID: 37716742 DOI: 10.1016/j.cpm.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Subtalar joint arthrodesis is a commonly used procedure for numerous pathologic conditions in the foot and ankle. Although rarely performed in isolation, this procedure can provide successful resolution of various lower-extremity complaints. There are traditional approaches to isolated subtalar joint arthrodesis; however, when these fail, the authors recommend alternatives to enhance the success of revisional surgery. These include the use of intramedullary nailing, larger harvest of autograft, and metallic wedge.
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Affiliation(s)
- Ryan J Lerch
- The Reconstruction Institute, The Bellevue Hospital, 1400 West Main Street, Bellevue, OH 44811, USA
| | - Amar Gulati
- Progressive Feet, 611 South Carlin Springs Road, Suite 508, Arlington, VA 22204, USA
| | - Peter D Highlander
- The Reconstruction Institute, The Bellevue Hospital, 1400 West Main Street, Bellevue, OH 44811, USA.
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Woo SH, Goh TS, Ahn TY, You JS, Bae SY, Chung HJ. Subtalar distraction arthrodesis for calcaneal malunion - comparison of structural freeze-dried versus autologous iliac bone graft. Injury 2021; 52:1048-1053. [PMID: 33423772 DOI: 10.1016/j.injury.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/04/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to analyze the outcomes of subtalar distraction arthrodesis (SDA) for calcaneal malunion using structural freeze-dried iliac allograft (FDIA) compared to using autologous iliac bone (AIB). METHODS We retrospectively evaluated 57 consecutive cases (51 patients) of calcaneal malunion between March 2006 and December 2017. All patients were followed for an average of 22.8 months. All cases were treated by SDA using structural FDIA (17 cases, group 1), or AIB (40 cases, group 2). The outcome measures included the American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores, visual analog scale (VAS) pain scores, and radiographic measurements. RESULTS The mean postoperative 3, 6, and 12 months of AOFAS scores and VAS pain score were significantly better in group 2 than those in group 1 (p < 0.05, for all). There were 3 cases (17.6%) of nonunion in the group 1, whereas the group 2 had 2 cases (5.0%), which did not shown significant difference between two groups (p = 0.492). Although the mean pre-, postoperative, and final follow-up radiologic parameters in both groups were similar, (p > 0.05, for all) the difference of talocalcaneal height, talocalcaneal angle, and talar declination angle from postoperative to final follow-up were significantly bigger in the group 1. (p < 0.05, for all). CONCLUSION Although union rate was not significantly different between the two groups, we obtained more favorable clinical and radiologic outcomes in the autologous iliac bone group. Using FDIA without any orthobiological agent for SDA, there were significant more loss of radiological parameters due to inferior incorporation and biomechanical properties. When considering the SDA for calcaneal malunion, routine use of FDIA without any orthobiological agents as an interpositional graft for SDA is not recommended.
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Affiliation(s)
- Seung Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Republic of Korea
| | - Tae-Sik Goh
- Department of Orthopedic Surgery, Pusan National University Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea
| | - Tae-Young Ahn
- Department of Orthopedic Surgery, Pusan National University Hospital, 179 Guduk-ro, Seo-gu, Busan 49242, Republic of Korea
| | - Jun Sang You
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Su-Young Bae
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Hyung-Jin Chung
- Department of Orthopedic Surgery, Inje University, Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea.
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Sadek AF, Fouly EH, Soliman AM. Combined subtalar distraction arthrodesis with peroneus brevis tenotomy for posttraumatic subtalar arthritis. Foot Ankle Surg 2020; 26:687-692. [PMID: 31492519 DOI: 10.1016/j.fas.2019.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/25/2019] [Accepted: 08/22/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar distraction arthrodesis is advocated as a salvage procedure for isolated posttraumatic subtalar arthritis. This study aimed at evaluating combined subtalar distraction arthrodesis with peroneus brevis tenotomy for such cases. METHODS Twenty patients with isolated posttraumatic subtalar arthritis managed by combined subtalar distraction arthrodesis and peroneus brevis tenotomy were reviewed for a retrospective study. The American orthopaedic foot and ankle society [AOFAS] hindfoot scoring, talocalcaneal height [TCH], talocalcaneal angle [TCA] and heel valgus angle [HVA] were used for both pre and postoperative assessments. RESULTS The mean postoperative [TCH] [70.3±1.9mm] was statistically better than the preoperative value [64.7±2.2mm] [p<0.001]. There was a statistically significant decrease in [HVA] [p<0.001]. On the contrary, there was a statistically significant increase in both [AOFAS] hindfoot scoring and the [TCA] [p<0.001]. CONCLUSIONS Applying this technique for isolated posttraumatic subtalar arthritis with peroneal tendinitis improved both lateral retromalleolar swelling and deformity correction.
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Affiliation(s)
- Ahmed Fathy Sadek
- Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt.
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Fletcher AN, Liles JL, Steele JJ, Pereira GF, Adams SB. Systematic Review of Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis. Foot Ankle Int 2020; 41:437-448. [PMID: 31958992 DOI: 10.1177/1071100719899050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objective of this study was to present an overview of outcomes following SDA, focusing on surgical technique as well as clinical and radiographic results. METHODS MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least 5 patients, and (4) reporting clinical and/or radiographic outcomes of SDA. RESULTS Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle-hindfoot scores with a weighted average of 33 points of improvement. CONCLUSION SDA provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. Higher quality studies are necessary to better assess outcomes between different operative techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Jordan L Liles
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Johnathan J Steele
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Gregory F Pereira
- Department of Orthopaedics, Orthopaedic Surgery Resident, Duke University Medical Center, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedics, Duke Medical Center, Durham, NC, USA
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Niazi NS, Aljawadi A, Pillai A. Shaped titanium wedges for subtalar distraction arthrodesis: Early clinical and radiological results. Foot (Edinb) 2020; 42:101647. [PMID: 32035402 DOI: 10.1016/j.foot.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/05/2019] [Accepted: 10/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Displaced intraarticular calcaneum fractures are associated with late symptomatic hind foot malalignment and painful arthrosis for which distraction subtalar fusion might be considered. During subtalar distraction arthrodesis, a structural graft is often used to fill gaps. Autograft, the current gold standard, is limited in availabilityand is associated with donor-site morbidity and collapse. Allografts have the risk of infectious disease transmission, rejection and failure to integrate. The clinical outcomes and midterm results of subtalar distraction arthrodesis with biofoamtitanium wedges are presented. METHODS A review of 4 patients (3 male and 1 female) undergoing subtalar bone block distraction arthrodesis using biofoam titanium wedges is reported. Results were evaluated clinically and radiologically Mean time from trauma to surgery was 27.5 months and mean follow up was 12 months. RESULTS The mean FAAM ADL score improved from 31.4% preoperatively to 74.2% postoperatively and mean AOFAS score improved from 23.4 preoperatively to 69.6 postoperatively.There was improvement in all radiographic parameters, with 44% improvement in calcaneal pitch, 23% improvement in talocalcaneal angle, 21% increase in talus-first metatarsal angle, and 13.5% correction of talocalcaneal height. VAS Pain scores wasimproved from a pre-operative mean of 8 to a post-operative mean of 2. Mean time to fusion was 13 weeks. Union was achieved in all cases. CONCLUSION Our data suggest titanium wedges may be used as a structural graft option for subtalar bone block distraction arthrodesis. Fusion rates and time to incorporation are comparable to autogenous bone graft without the associated morbidity. Level IV Case Series.
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Affiliation(s)
- Noman Shakeel Niazi
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester University Foundation Trust, United Kingdom.
| | - Ahmed Aljawadi
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester University Foundation Trust, United Kingdom.
| | - Anand Pillai
- Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester University Foundation Trust, United Kingdom.
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Farouk A, Ibrahim A, Abd-Ella MM, El Ghazali S. Effect of Subtalar Fusion and Calcaneal Osteotomy on Function, Pain, and Gait Mechanics for Calcaneal Malunion. Foot Ankle Int 2019; 40:1094-1103. [PMID: 31165638 DOI: 10.1177/1071100719853291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Calcaneal malunion is a common complication of nonoperative management of calcaneal fracture, which leads to a disruption of the biomechanics of the lower extremity, pain, and permanent disability. Our aim was to evaluate pain, function, and gait after combined subtalar joint fusion, calcaneal osteotomy, and lateral wall exostectomy for patients with neglected calcaneal fractures with malunion. METHODS Eighteen patients with malunited calcaneal fractures, varus deformity, and subtalar arthritis were operated upon and then followed up for 18 months. All cases were assessed clinically using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS); radiologically by measuring the talar inclination, talocalcaneal and talus-first metatarsal angles, and talocalcaneal height; and biomechanically by measuring the stride duration, step width, comfortable speed, and ground reaction forces in relation to the body weight. RESULTS A significant improvement in AOFAS (59.8 preoperatively to 80.2 after 18 months) and VAS (61.1 preoperatively to 29.4) was found. Also, our study revealed a significant improvement in the radiographic measurements including the valgus angle, the talocalcaneal angle, the talocalcaneal height, and the talar inclination angle. The gait analysis found that the maximum loading force in the push-off phase and comfortable speed yielded a significant improvement postoperatively. However, no significant differences between the preoperative data and the final follow-up in terms of the step width, stride duration, maximum peak force during loading phase, and minimum peak force during midstance phase were found. CONCLUSION The combination of valgus calcaneal osteotomy, lateral wall exostectomy, and subtalar fusion resulted in pain reduction, improved function, and better gait. However, the limited bone stock for the graft used in the subtalar fusion made use of this technique in severely reduced height unadvisable. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Amr Farouk
- 1 Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Ibrahim
- 1 Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Persaud SJ, Catanzariti AR. Subtalar Joint Distraction Arthrodesis Utilizing a Titanium Truss: A Case Series. J Foot Ankle Surg 2019; 58:785-791. [PMID: 31010769 DOI: 10.1053/j.jfas.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 02/03/2023]
Abstract
Subtalar joint distraction arthrodesis has been recommended for the treatment of conditions such as nonunion or malunion of subtalar joint arthrodesis posttraumatic arthritis. Both conditions are difficult to treat, because the deformities created in the frontal and sagittal planes of these conditions are complex. If these malalignments are not addressed, ankle joint instability and wear occur over time. In general, either autograft or allograft bone has been used to perform distraction arthrodesis of the subtalar joint. Although studies have shown successful use, there have been complications. Autografts have resulted in donor site morbidity and limitations on graft size, and allografts have shown high nonunion rates. Both autografts and allografts have shown graft collapse over time. Recent literature has discussed the use of tantalum technology to span large defects in bone healing. Studies have shown that tantalum provides superior strength and bone incorporation compared with autografts and allografts. This case series presents 2 cases in which tantalum truss technology was used for distraction arthrodesis. Although this series is limited in patient numbers, both cases show effective graft incorporation with no loss in height over time and earlier return to activity compared with previous studies that used autograft and allograft wedges.
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Affiliation(s)
- Sham J Persaud
- Resident, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Faculty, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA.
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Duan XJ, Fan HQ, Wang FY, He P, Yang L. Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis. Orthop Surg 2019; 11:405-413. [PMID: 31106975 PMCID: PMC6595118 DOI: 10.1111/os.12464] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/08/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. METHODS We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. RESULTS All customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). CONCLUSION It is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.
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Affiliation(s)
- Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fu-You Wang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Peng He
- Chongqing Institute of Optics and Mechanics, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Thompson MJ, Roukis TS. Management of Calcaneal Fracture Malunion with Bone Block Distraction Arthrodesis: A Systematic Review and Meta-Analysis. Clin Podiatr Med Surg 2019; 36:307-321. [PMID: 30784539 DOI: 10.1016/j.cpm.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
One of the most severe complications in calcaneal fractures is a malunion. When a malunion occurs, subtalar bone block distraction arthrodesis provides restoration of calcaneal height, length, correction of varus deformity, and elimination of subtalar joint arthritis. A systematic review showed the union rate for all procedures was 95.78%. The overall complication rate was 38% for all procedures. This is the first study to categorically break down complications with statistical analysis. The data presented indicate the level of difficulty of the subtalar distraction bone block arthrodesis for calcaneal malunions and may even suggest the need for newer techniques.
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Affiliation(s)
- Mitchell J Thompson
- Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, Mail Stop CO3-006A, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Orthopaedic Center, Gundersen Healthcare System, Mail Stop CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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Abstract
The subtalar joint can be altered in its anatomy and biomechanical behavior. It is important to know how to assess the talar declination angle in order to assess the deformity at the subtalar joint. Consider a straight posterior approach to the subtalar joint and remain liberal in the use of z-shaped Achilles tendon lengthening. A structural bone graft should be used to elevate the talus. Positioning screws should be used to lock the construct.
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Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Elena Vacas
- Institute for Foot and Ankle Reconstruction, Kappelistrasse 7, Zurich 8002, Switzerland
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Tricot M, Deleu PA, Detrembleur C, Leemrijse T. Clinical assessment of 115 cases of hindfoot fusion with two different types of graft: Allograft+DBM+bone marrow aspirate versus autograft+DBM. Orthop Traumatol Surg Res 2017; 103:697-702. [PMID: 28416462 DOI: 10.1016/j.otsr.2017.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 02/13/2017] [Accepted: 03/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Nonunion is a common complication (15%) of hindfoot and ankle arthrodesis. Autograft can improve the fusion rate because of its osteoconductive, osteoinductive and osteogenic properties. However, autograft harvesting is a source of morbidity. One alternative is to combine allograft with demineralized bone matrix (DBM) and iliac bone marrow aspirate (BMA). This combination graft has similar biological properties to healthy bone. When used alone, allograft has osteoconductive and sometimes structural properties. DBM provides osteoinduction and improves the osteconductivity. BMA adds cells and thereby osteogenic potential. HYPOTHESIS Given its intrinsic properties, allograft-DBM-BMA is as effective as autograft-DBM treatment while simplifying the clinical practice. MATERIAL AND METHODS One hundred and fifteen cases of ankle and hindfoot arthrodesis were studied in 82 patients divided in two groups: autograft-DBM vs allograft-DBM-BMA. Treatment effectiveness was assessed using clinical (time to fusion, fusion rate) and radiological (trabecular bone bridge, disappearance of joint space) criteria. A CT scan was done in 60% of cases when fusion could not be confirmed using the clinical and radiological criteria. RESULTS There was no significant difference between the two groups in terms of fusion rate, time to fusion, number of heterotopic ossifications, revision rate and quantity of DBM used. The nonunion rate was 18% in the autograft group and 13% in the allograft group. The infection rate was 11% in the autograft and 4% in the allograft group. DISCUSSION Allograft-DBM-BMA is an alternative to autograft-DBM that provides similar effectiveness without increasing the number of nonunion or complications. Osteonecrosis and surgical revision are risk factors. LEVEL OF EVIDENCE III retrospective study.
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Affiliation(s)
- M Tricot
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgium.
| | - P-A Deleu
- Foot and Ankle Institute, 5, avenue Ariane, 1200 Bruxelles, Belgium
| | - C Detrembleur
- Université catholique de Louvain, pôle de recherche CARS, institut de recherche expérimentale et clinique, 53, avenue Mounier, 1200 Bruxelles, Belgium
| | - T Leemrijse
- Foot and Ankle Institute, 5, avenue Ariane, 1200 Bruxelles, Belgium
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Wang S, Li J, Huang F, Liu L. [Application and research progress of subtalar distraction bone block arthrodesis in treatment of calcaneus fracture malunion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:755-759. [PMID: 29798661 PMCID: PMC8498293 DOI: 10.7507/1002-1892.201611058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/13/2017] [Indexed: 02/05/2023]
Abstract
Objective To review the application and research progress of subtalar distraction bone block arth-rodesis in the treatment of calcaneus fracture malunion. Methods The recent literature concerning the history, surgical technique, postoperative complication, indications, and curative effect of subtalar distraction arthrodesis with bone graft block interposition in the treatment of calcaneus fracture malunion was summarized and analyzed. Results Subtalar distraction bone block arthrodesis is one of the main ways to treat calcaneus fracture malunion, including a combined surgery with subtalar arthrodesis and realignment surgery for hindfoot deformity using bone block graft. The advantage is on the base of subtalar joint fusion, through one-time retracting subtalar joint, the posterior articular surface of subtalar joint implants bone block can partially restore calcaneal height, thus improving the function of the foot. Compared with other calcaneal malunion treatments, subtalar distraction arthrodesis is effective to correct complications caused by calcaneus fracture malunion, and it can restore the height of talus and calcaneus, correct loss of talocalcaneal angle, and ease pain. Conclusion Subtalar distraction bone block arthrodesis has made remarkable progress in the treatment of calcaneus fracture malunion, but it has the disadvantages of postoperative nonunion and absorption of bone block, so further study is needed.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jun Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Lei Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Monaco SJ, Brandao RA, Manway JM, Burns PR. Subtalar Distraction Arthrodesis with Fresh Frozen Femoral Neck Allograft: A Retrospective Case Series. Foot Ankle Spec 2016; 9:423-8. [PMID: 27370651 DOI: 10.1177/1938640016656783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Subtalar joint distraction arthrodesis has been well reported with use of structural iliac crest or local autologous bone graft for malunited calcaneal fractures. Early reports for structural allograft did not yield good, consistent results, leading to a subsequent lack of recommendation in previous literature. Newer studies have had promising results utilizing femoral allograft as an alternative to autogenous bone graft. We performed a retrospective chart review on 10 patients (12 feet) undergoing subtalar joint distraction arthrodesis with femoral neck allograft for malunited calcaneal fractures. The primary aim of this study was to report on successful union rates and, in addition, outline any consistent complications. Twelve of the 12 procedures (100%) yielded successful fusion with a mean final follow-up of 7.7 months (range = 2.2-35.1 months). The mean increase in talocalcaneal height was 4 mm (range = 2-6 mm). The overall complication rate was 16.6%, including one superficial wound complication that healed uneventfully and one hardware removal. In conclusion, the current study reports a 100% successful fusion rate with interpositional structural femoral neck allograft in treatment for malunited calcaneal fractures. LEVELS OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Spencer J Monaco
- University of Pittsburgh Medical Center Podiatric Medicine and Surgical Residency Program (SJM, RAB, JMM, PRB), Pittsburgh, PennsylvaniaDepartment of Orthopedics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (JMM, PRB)
| | - Roberto A Brandao
- University of Pittsburgh Medical Center Podiatric Medicine and Surgical Residency Program (SJM, RAB, JMM, PRB), Pittsburgh, PennsylvaniaDepartment of Orthopedics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (JMM, PRB)
| | - Jeffrey M Manway
- University of Pittsburgh Medical Center Podiatric Medicine and Surgical Residency Program (SJM, RAB, JMM, PRB), Pittsburgh, PennsylvaniaDepartment of Orthopedics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (JMM, PRB)
| | - Patrick R Burns
- University of Pittsburgh Medical Center Podiatric Medicine and Surgical Residency Program (SJM, RAB, JMM, PRB), Pittsburgh, PennsylvaniaDepartment of Orthopedics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (JMM, PRB)
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Yuan CS, Tan XK, Zhou BH, Liu JP, Tao X, Tang KL. Differential efficacy of subtalar fusion with three operative approaches. J Orthop Surg Res 2014; 9:115. [PMID: 25407539 PMCID: PMC4247699 DOI: 10.1186/s13018-014-0115-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022] Open
Abstract
Background There are many existing operative approaches for subtalar fusion; however, no optional strategy of operative approach has been developed yet. This study aimed to analyze the differential clinical efficacy of subtalar fusion with three operative approaches. Methods The clinical data of 102 patients from April 2008 to April 2012 were analyzed prospectively. These patients were divided into three groups with the random number table: group A, group B, and group C. The following parameters were compared among three groups: effective exposure area and exposure time of subtalar joint, intraoperative bleeding volume, postoperative complications, fusion time, fusion rate, AOFAS score and VAS score before and after operation. Results In the exposure area score, there was no statistically significant difference between group A and group C (P >0.05) ,but with a statistically significant difference between group A/C and group B (P <0.05). In exposure time and intraoperative bleeding volume, there was no statistically significant difference between group A and group B (P >0.05) but with a statistically significant difference between group A/B and group C (P <0.05). In three groups, there was a statistically significant difference in both AOFAS score and VAS score before operation and at 6 months/12 months/last visit after operation (P <0.05). The incidence of complications in the three groups was 8.8%, 12.5% and 19.4%. No statistically significant differences in fusion rate and fusion time were observed among the three groups (P >0.05). Conclusion Three operative approaches have different indications, All the three operative approaches do not influence the fusion rate and fusion time of subtalar joint. The lateral tarsal sinus approach is inferior to the posterior-lateral L approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone in the exposure area, while the lateral tarsal sinus approach and the approach from the inferior tip of fibula to the basilar part of the fourth metatarsal bone are superior to the posterior-lateral L approach in the exposure time, intraoperative bleeding volume, and incidence of complications. Level of evidence Therapeutic, level III.
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Affiliation(s)
- Cheng-song Yuan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Xiao-kang Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Bing-Hua Zhou
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Jun-peng Liu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Xu Tao
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
| | - Kang-Lai Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, No. 30, Gaotanyan Road, Chongqing, 400038, China.
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15
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Loder BG, Dunn KW. Functional reconstruction of a calcaneal deficit due to osteomyelitis with femoral head allograft and tendon rebalance. Foot (Edinb) 2014; 24:149-52. [PMID: 24835572 DOI: 10.1016/j.foot.2014.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
Abstract
Calcaneal osteomyelitis is one of the most devastating complications encountered with the surgical treatment of calcaneal fractures. Previous treatments have focused on infection ablation, followed by either bracing or amputation. Few reports have focused on a staged procedure and ultimate functional reconstruction of the calcaneus. The case presented utilized a flexor hallucis longus tendon transfer with reattachment of the Achilles tendon, and implantation of a femoral head allograft. At 24 month follow-up, the patient was able to return to all pre-injury activities, without bracing or assistance.
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Affiliation(s)
- Brian G Loder
- Residency Director, Henry Ford Macomb Hospital, Clinton Township, MI, United States
| | - Karl W Dunn
- Henry Ford Macomb Hospital, Clinton Township, MI, United States.
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16
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Chung HJ, Bae SY, Choo JW. Mid-term follow up results of subtalar distraction arthrodesis using a double bone-block for calcaneal malunion. Yonsei Med J 2014; 55:1087-94. [PMID: 24954341 PMCID: PMC4075371 DOI: 10.3349/ymj.2014.55.4.1087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
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, 1.8° in talocalcaneal angle, 5.1° in talar declination angle and 5.3° 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.
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Affiliation(s)
- Hyung-Jin Chung
- Orthopaedic Department, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Su-Young Bae
- Orthopaedic Department, Inje University Sanggye Paik Hospital, Seoul, Korea.
| | - Ji-Woong Choo
- Orthopaedic Department, Inje University Sanggye Paik Hospital, Seoul, Korea
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17
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Angthong C, Khadsongkram A, Angthong W. Outcomes and quality of life after platelet-rich plasma therapy in patients with recalcitrant hindfoot and ankle diseases: a preliminary report of 12 patients. J Foot Ankle Surg 2013; 52:475-80. [PMID: 23651695 DOI: 10.1053/j.jfas.2013.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Indexed: 02/03/2023]
Abstract
The present study aimed to determine the outcomes and quality of life after platelet-rich plasma therapy in patients with chronic recalcitrant diseases of the hindfoot and ankle and to identify the crucial clinical variables. The records of 12 adult patients with diseases of the hindfoot and ankle were included in the present study. These patients had been treated with platelet-rich plasma from September 2010 to April 2011 after 3 to 6 months or more of conservative treatment had been unsuccessful. They had attended the follow-up visits, were consecutively enrolled, and retrospectively studied. A total of 3 mL of autologous platelet-rich plasma was injected under fluoroscopic or ultrasound guidance into the affected areas. All patients had been evaluated using visual analog scale foot and ankle scoring before treatment and at set intervals after treatment. According to their scores at the final follow-up visit (mean 16 months), the patients were allocated to the satisfactory (score ≥ 80; n = 8) and unsatisfactory (score < 80; n = 4) groups. The health-related quality of life was assessed using the Medical Outcomes Study short-form, 36-item survey at the final follow-up visit, because the study was retrospective, and the information was not available before treatment. The mean visual analog score at the final follow-up visit (79.71 ± 17.81) was significantly greater than the mean pretreatment score (57.89 ± 20.77; p = .002). Four patients (33%) had unsatisfactory results. The mean short-form, 36-item score for the satisfactory group (85.23 ± 11.30) was significantly greater than that (57.33 ± 12.91) of the unsatisfactory group (p = .003). No definitive factors influencing the outcome of this treatment were found. The substantial number of patients with an unsatisfactory outcome indicates that platelet-rich plasma injection might be an option but might not be a mainstay of nonoperative treatment of problematic conditions of the hindfoot and ankle. The actual benefit of this treatment, including the factors influencing its outcome, are still inconclusive.
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Affiliation(s)
- Chayanin Angthong
- Division of Foot and Ankle Surgery, Department of Orthopedic Surgery, Thammasat University Faculty of Medicine, Klong Nueng, Klong Luang, Pathum Thani, Thailand.
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18
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Chiang CC, Tzeng YH, Lin CFJ, Huang CK, Chen WM, Liu CL, Chen TH. Subtalar distraction arthrodesis using fresh-frozen allogeneic femoral head augmented with local autograft. Foot Ankle Int 2013; 34:550-6. [PMID: 23463777 DOI: 10.1177/1071100713481432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tricortical autograft has been commonly used in subtalar distraction arthrodesis (SDA) for severe calcaneal malunion. Structural allograft enriched with orthobiological agents is an alternative. This study was performed to evaluate the results of SDA using fresh-frozen allogeneic femoral head without the addition of orthobiological agents. MATERIALS AND METHODS We retrospectively reviewed 15 consecutive SDA procedures (13 patients) with allogeneic femoral head augmented with local autograft for the treatment of severe calcaneal malunion. Clinical outcome was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) pain score, Short Form-12 (SF-12), range of motion (ROM) of the ankle joint, and patient satisfaction rate. Radiographic assessment included the talar declination angle (TDA), calcaneal inclination angle (CIA), lateral talocalcaneal angle (LTCA), heel height, calcaneal length, and union time. RESULTS At a median follow-up of 36.0 months (range, 24-47 months), all 15 feet (100%) achieved union, at a median of 13.0 weeks (range, 12-18 weeks). The AOFAS score and VAS pain score improved significantly, with a satisfaction rate of 93.3%. The TDA, CIA, LTCA, and heel height improved significantly. The median increase in heel height was 8.6 mm (range, 1.9-20.1 mm). There was a significant reduction in calcaneal length. Complications included 1 varus malalignment, 1 complex regional pain syndrome, 1 hardware irritation, and 1 sural neuralgia. CONCLUSION This study found that SDA using fresh-frozen femoral head allograft without an orthobiological agent was cost-effective and may have outcomes comparable to those using autograft or allograft enriched with orthobiological agents.
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Affiliation(s)
- Chao-Ching Chiang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
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19
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Schepers T. The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: a systematic review. Foot (Edinb) 2013. [PMID: 23177597 DOI: 10.1016/j.foot.2012.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The primary aim of the current review study was to assess the functional outcome of the subtalar distraction bone block arthrodesis in the management of late complications of displaced intra-articular calcaneal fractures. METHODS The literature was searched for studies in which a subtalar distraction bone block arthrodesis was used in the management of persistent complaints following a displaced intra-articular calcaneal fractures, after its first description in 1988 up to November 1st 2011. The methodological quality of the included studies was assessed using the Coleman Methodology Score. RESULTS Twenty-one studies reporting on 456 patients were identified. In 93 percent the procedure was a salvage procedures following the late complications of a calcaneal fracture (372 cases). Duration of follow-up ranged from 21 to 108 months (average 40 months). Union rates were reported with an overall average of 96% (range 83-100%). The average modified AOFAS score (maximum 94 points) was 73 points at final follow-up (range 64-83 points). Six studies reported pre- and post-reconstruction AOFAS outcome scores with an average increase of 44.2 points. Wound complications occurred in approximately 6%. With the exception of one study all were level 4 retrospective case series, with an average Coleman Methodology Score of 55 (range 41-79) points. CONCLUSIONS The subtalar distraction bone block arthrodesis is a technically demanding procedure which, in the right hands, provides an overall good result. This is reflected in a significant increase in outcome scores post-operatively. Although most complications are considered minor, there are several pitfalls which should be recognized and avoided.
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Affiliation(s)
- T Schepers
- Erasmus MC, University Medical Center Rotterdam, Department of Surgery-Traumatology, The Netherlands.
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20
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Treatment for calcaneal malunion. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:961-6. [DOI: 10.1007/s00590-012-1110-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
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21
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Shibuya N, Agarwal MR. Distraction arthrodesis of subtalar joint using a laterally placed hinged distractor. J Foot Ankle Surg 2012; 51:820-4. [PMID: 22974814 DOI: 10.1053/j.jfas.2012.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Indexed: 02/03/2023]
Abstract
Many joint-depressive, neglected calcaneal fractures need distraction arthrodesis of the subtalar joint. Because the calcaneal tuberosity is usually malunited in the varus position, more distraction is required on the medial side to place the tuberosity in the everted position before insertion of a bone graft. Traditionally, a distractor is placed on the medial side to achieve this task. However, the medially placed distractor hinders with the positioning of the extremity and exposure of the main operative site, which is commonly on the lateral side. We introduce a technique to avoid this burden by placing a hinged distractor device on the lateral aspect of the foot while maintaining the correction of the varus deformity.
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Affiliation(s)
- Naohiro Shibuya
- Texas A&M Health and Science Center, College of Medicine, Temple, TX 76504, USA.
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22
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Palmersheim K, Hines B, Olsen BL. Calcaneal fractures: update on current treatments. Clin Podiatr Med Surg 2012; 29:205-20, vii. [PMID: 22424485 DOI: 10.1016/j.cpm.2012.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Calcaneal fractures represent 2% of all fractures and account for approximately 60% of all tarsal injuries. Motor vehicle collisions and falls are the major causes of these large force compression injuries, causing widening of the heel, loss of heel height, and articular surface displacement. A correlation has been shown between restoration of normal anatomy and satisfactory functional outcome. Once the basic principles of calcaneal fractures are understood, including the anatomy, the radiographic findings, and the challenges that these complicated fractures present, the physician can then be ready with the armamentarium that allows for a patient-specific and injury-specific plan.
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Affiliation(s)
- Kathie Palmersheim
- Department of Foot and Ankle Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
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