Yonsei Med J.  2014 Jul;55(4):1087-1094. 10.3349/ymj.2014.55.4.1087.

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

• Chung HJ
• Bae SY
• Choo JW

• KMID: 2130837
• DOI: http://doi.org/10.3349/ymj.2014.55.4.1087

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, 1.8degrees in talocalcaneal angle, 5.1degrees in talar declination angle and 5.3degrees in talo-first metatarsal angle.
CONCLUSION
Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.

Keyword

Calcaneus; malunion; subtalar distraction arthrodesis; double bone-block

MeSH Terms

Adult
Arthrodesis/methods
Calcaneus/*injuries/surgery
Female
Fractures, Malunited/*surgery
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 A, talo-calcaneal height; B, talo-calcaneal angle; C, talar declination angle; D, talo-1st metatarsal angle.

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  Fig. 2 Procedures of the operation. (A) Surgical approach for distraction arthrodesis. (B) Distraction and preparation of subtalar joint. (C) Insertion of two trapezoidal shaped tricortical bone blocks.

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  Fig. 3 Preparation of double bone block.

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  Fig. 4 Right foot-ankle lateral view & axial view (A) initial, (B) immediate postoperation, (C) postoperative 3 months, and (D) final follow-up (screw removal stage).

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