Twenty-two patients underwent a posterior bone block distraction arthrodesis of the
subtalar joint between 1999 and 2006. The indication for surgery was loss of heel
height, subtalar joint arthrosis, decreased talar declination with associated tibiotalar
impingement, insufficient Achilles tendon function, malalignment of the rear foot,
and pain with ambulation. There were 11 male and 11 female patients with a mean age
of 46.7 years (range 20 to 71). The mean follow-up period was 27.3 months (range 12
to 63.9 months). Radiographic analysis revealed a mean increase in heel height of
6.09 mm (P = .0001), 5.83° (P = .12) of lateral talocalcaneal angle, 5.5° (P = .06) of talar declination, and 5.23° (P = .07) of calcaneal inclination. The talo-first metatarsal angle increased an average
of 4.5° (P = .18). There was a 95.5% union rate. Postoperative complications included nonunion
in 1 patient, subsidence of graft (collapse) in 1 patient, wound dehiscence in 3 patients,
painful hardware in 7 patients, sural neuritis in 1 patient, superior cluneal nerve
dysfunction in 1 patient and one mild varus malunion. Posterior bone block distraction
arthrodesis can be successfully used to restore heel height, realign the foot, and
decrease the morbidity associated with late complications of calcaneal fractures,
as well as, nonunion and/or malunion following subtalar joint arthrodesis, Charcot
neuroarthropathy, and avascular necrosis of the talus. Level of Clinical Evidence:
4.
Key Words
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References
- Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture.Foot Ankle Int. 1996; 17: 608-614
- Block distraction arthrodesis for the treatment of failed calcaneal fractures.Clin Podiatr Med Surg. 2004; 21: 241-250
- Subtalar distraction bone block fusion for late complications of os calcis fractures.Foot Ankle. 1988; 9: 81-86
- Late results of subtalar distraction fusion.Foot Ankle Int. 1998; 19: 197-202
- Subtalar arthrodesis with interposition tricortical iliac crest graft for late pain and deformity after calcaneus fracture.Foot Ankle Int. 1997; 18: 613-615
- Subtalar distractional realignment arthrodesis with wedge bone grafting and lateral decompression for calcaneal malunion.J Trauma. 1998; 45: 729-737
- Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.J Bone Joint Surg. 2005; 87A: 963-973
- Late complications of fractures of the calcaneus.J Bone Joint Surg. 1993; 75A: 331-341
- Subtalar distraction arthrodesis using a ramp cage.Orthopedics. 2003; 26: 1117-1119
- Complications of midfoot and hindfoot arthrodesis.Clin Orthop Relat Res. 2001; 391: 45-58
- Subtalar distraction bone block fusion: an assessment of outcome.Foot Ankle Int. 1997; 18: 785-791
- Subtalar distraction bone block arthrodesis.J Bone Joint Surg. 2001; 83B: 849-854
- Foot function after subtalar distraction bone-block arthrodesis.J Bone Joint Surg Br. 2004; 86B: 659-668
- Radiographic measurements of the normal adult foot.Foot Ankle. 1980; 1: 151-158
- Subastragalar arthrodesis in fractures of the os calcis.J Bone Joint Surg. 1943; 25: 731-736
Article info
Publication history
Published online: March 10, 2008
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2008 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
