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Lee SW, Yon CJ, Kim JH, Lee JM, Lee JH, Heo YR. Comparison of the Usefulness of Computer-Assisted Three-Dimensional Analysis and Weight-Bearing Radiographs in Ankle Osteoarthritis. Clin Orthop Surg 2024; 16:141-148. [PMID: 38304214 PMCID: PMC10825248 DOI: 10.4055/cios23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 02/03/2024] Open
Abstract
Background To evaluate the degree of deformation in patients with ankle osteoarthritis (OA), it is essential to measure the three-dimensional (3D), in other words, stereoscopic alignment of the ankle, subtalar, and foot arches. Generally, measurement of radiological parameters use two-dimensional (2D) anteroposterior and lateral radiographs in a weight-bearing state; however, computer-aided 3D analysis (Disior) using weight-bearing cone-beam computed tomography (CBCT) has recently been introduced. Methods In this study, we compared the 2D human radiographic method with a stereoscopic image in patients with ankle arthritis. We enrolled 57 patients diagnosed with OA (28 left and 29 right) and obtained both standing radiographs and weight-bearing CBCT. Patients were divided by the Takakura stage. The interclass correlation coefficient (ICC) for each result was confirmed. Results On the ICC between 2D radiographs and 3D analysis, the tibiotalar surface angle and lateral talo-1st metatarsal angle showed a good ICC grade (> 0.6), while other parameters did not have significant ICC results. Three-dimension was superior to radiographs in terms of statistical significance. Conclusions We demonstrated that 2D and stereoscopic images are useful for the diagnosis of OA. Our study also confirmed that the radiographic features affected by ankle OA varied. However, according to the results, the typical radiography is not sufficient to diagnose and determine a treatment plan for ankle OA. Therefore, the method of using 3D images should be considered.
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Affiliation(s)
- Si-Wook Lee
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Chang-Jin Yon
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae-Ho Kim
- Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jung-Min Lee
- Industry-Academic Cooperation Foundation, Keimyung University, Daegu, Korea
| | - Jae-Ho Lee
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
| | - Yu-Ran Heo
- Department of Anatomy, Keimyung University College of Medicine, Daegu, Korea
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Stone R, Dao T, Hill Z, Malay DS, Mendicino R. Defining the Structures at Risk and an Anatomical Safe Zone for Percutaneous Antegrade Subtalar Joint Fixation With a Single Screw: A Cadaveric Study. J Foot Ankle Surg 2024; 63:50-54. [PMID: 37666469 DOI: 10.1053/j.jfas.2023.08.012] [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: 03/30/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/06/2023]
Abstract
Percutaneous antegrade (anterior to posterior) fixation for subtalar joint (STJ) arthrodesis offers various intraoperative and biomechanical advantages. Currently, the entry point for percutaneous antegrade STJ screw fixation is not clearly described and variable. To our knowledge, there are no publications that evaluate anatomic structures at risk or define an anatomically safe entry point for this fixation. The aim of this investigation was to define an anatomically safe and reproducible entry point for percutaneous antegrade STJ arthrodesis fixation, while also describing anatomic structures at risk when undertaking this method of fixation. We hypothesized that percutaneous single screw antegrade STJ fixation would encroach upon named anatomic structures in more than one cadaveric specimen. Ten cadaver limbs were used in this investigation. A percutaneous guidewire was inserted 5 mm lateral to the tibialis anterior tendon. The midpoint of the talar neck served as the sagittal plane starting point, as seen on the lateral fluoroscopic view. A cannulated 6.5-mm headed screw was inserted antegrade through the STJ into the calcaneus. Each specimen was dissected to assess the distance from the screw to nearby anatomic structures and distance from the tibialis anterior tendon to named structures. Our hypothesis was found to be incorrect, as 0/10 screws invaded neurovascular or tendinous structures. The dorsalis pedis artery and deep peroneal nerve were on average 12.1 ± 2.79 mm and 12.2 ± 2.82 mm lateral to the screw, respectively. These findings are clinically relevant and ultimately allow us to define an anatomic safe starting point for percutaneous antegrade STJ single screw fixation.
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Affiliation(s)
- Ryan Stone
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH.
| | - Tung Dao
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH
| | - Zachary Hill
- Resident Physician, Ohio Health Grant Medical Center, Columbus, OH
| | - D Scot Malay
- Staff Surgeon and Director of Podiatric Research, The Penn Presbyterian Medical Center, Philadelphia, PA
| | - Robert Mendicino
- Residency Program Director, OhioHealth Grant Medical Center, Columbus, OH
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Liu W, Li F, He H, Teraili A, Wang X, Wahapu P, Wang C. Biomechanical application of finite elements in the orthopedics of stiff clubfoot. BMC Musculoskelet Disord 2022; 23:1112. [PMID: 36544111 PMCID: PMC9768888 DOI: 10.1186/s12891-022-06092-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot. METHODS A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with "3°" of posterior varus, "0°" of a neutral position and "3°, 6°, 9°" of valgus as the correction angles. RESULTS The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus "6°". In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus "3°", neutral "0°", valgus "3°" and valgus "9°" compared with the preoperative stress. CONCLUSION The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of "6°" of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis.
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Affiliation(s)
- Wei Liu
- grid.459346.90000 0004 1758 0312The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Fei Li
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Haiyang He
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Aihelamu Teraili
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Xue Wang
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Paerhati Wahapu
- grid.460730.6The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
| | - Chengwei Wang
- grid.459346.90000 0004 1758 0312The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000 People’s Republic of China
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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.
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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.
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Jones JM, Vacketta VG, Philp FH, Catanzariti AR. Radiographic Outcomes of Isolated Subtalar Joint Arthrodesis With Varying Fixation Technique. J Foot Ankle Surg 2022; 61:938-943. [PMID: 34996652 DOI: 10.1053/j.jfas.2021.12.016] [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: 08/25/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.
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Affiliation(s)
- Jacob M Jones
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Vincent G Vacketta
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Frances Hite Philp
- Health Outcomes Researcher, AHN Research and Orthopaedic Institutes, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Director of Residency Training, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
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Kang HW, Kim DY, Park GY, Lee DO, Lee DY. Coronal plane Calcaneal-Talar Orientation in Varus Ankle Osteoarthritis. Foot Ankle Int 2022; 43:928-936. [PMID: 35484934 DOI: 10.1177/10711007221088566] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were (1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and (2) to determine if there is TT threshold at which apparent subtalar compensation begins to fade. METHODS We retrospectively reviewed 132 ankles that underwent weightbearing computed tomography (WBCT) for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT. RESULTS Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status (P < .001 and P = .030, respectively). The CIA of the noncompensated group varied widely, whereas the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel (sensitivity, 92.6%; specificity, 89.7%). CONCLUSION The position of the calcaneus appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is ≤9.5 degrees. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ho Won Kang
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Busan Paik Hospital, Busan, Republic of Korea
| | - Gil Young Park
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Republic of Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Wan J, Liu L, Zeng Y, Ren H, Zhang S. Comparison of different bone graft with arthroscopy-assisted arthrodesis for the treatment of traumatic arthritis of the subtalar joint. INTERNATIONAL ORTHOPAEDICS 2020; 44:2719-2725. [PMID: 32997156 DOI: 10.1007/s00264-020-04834-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/23/2020] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY To compare the clinical outcomes of traumatic arthritis of the subtalar joint treated by arthroscopy-assisted arthrodesis with autologous bone graft, allogenous bone graft, artifical bone graft, and no bone graft . METHODS Sixty-two patients (64 ft) with traumatic arthritis of subtalar joint were randomly divided into four groups. The cases treated with arthroscopy-assisted arthrodesis were analyzed retrospectively. The mean follow-up time was about 22 months (18-28 months) in each group. Clinical outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and radiographic examination. The post-operative complications in each group were recorded respectively. RESULTS All operations were successful, without incision complications. The subtalar joint obtained full osseous fusion in each group. The average time of osseous fusion was about 12 weeks. There was no significant difference in the fusion time with each group (P = 0.991). The AOFAS and VAS scores in each group were improved significantly in the pre-operative vs post-operative evaluation (all P < 0.01). The average operation time in autologous bone graft group was 74.56 ± 11.45 min which significantly different from that of other groups(P < 0.01). CONCLUSION Similar clinical outcomes were achieved among each type of bone graft. Therefore, which types of bone graft or not may be not the most important for arthroscopy-assisted subtalar arthrodesis.
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Affiliation(s)
- Junming Wan
- Department of joint surgery, The Seventh Affiliated Hospital, Sun Yet-sun University, No. 628 Zhenyuan road, Shenzhen, 518107, Guangdong, China. .,Zhujiang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Department of joint surgery, Tongde hospital of Zhejiang province, Hangzhou, 310002, Zhejiang, China.
| | - Liangle Liu
- Zhujiang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yuqing Zeng
- Department of joint surgery, Tongde hospital of Zhejiang province, Hangzhou, 310002, Zhejiang, China
| | - Haiyong Ren
- Department of joint surgery, Tongde hospital of Zhejiang province, Hangzhou, 310002, Zhejiang, China
| | - Shuliang Zhang
- Department of joint surgery, Tongde hospital of Zhejiang province, Hangzhou, 310002, Zhejiang, China.
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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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Abstract
Introduction An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults. Indications & Contraindications Step 1 Preoperative Planning Perform a comprehensive clinical and radiographic assessment. Step 2 Patient Positioning Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg. Step 3 Incision Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal. Step 4 Approach Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons. Step 5 Joint Preparation Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone. Step 6 Reduction and Fixation Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws. Step 7 Wound Closure Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position. Step 8 Postoperative Care The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks. Results Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications. Pitfalls & Challenges
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