Abstract
Distraction arthrodesis of the subtalar joint is often used for the correction of
neglected calcaneal fractures. Although different techniques have been advocated,
there remains some debate as to the optimal type of bone graft for this purpose. This
study retrospectively reviewed one surgeon's results for distraction arthrodesis of
the talocalcaneal joint for 15 consecutive feet in 15 patients using 12 frozen femoral
head and 3 freeze-dried iliac crest allografts. Indications for distraction arthrodesis
in this series included neglected calcaneal fracture (n = 10), failed open reduction
with internal fixation (n = 3), malunion after ankle fusion (n = 1), and subtalar
joint arthritis with deformity (n = 1). The mean patient age was 47.5 (range 29 to
66) years, and the mean duration of follow-up was 20.6 (range 13 to 31) months. Complete
union was achieved in 14 (93.33%) feet. Orthobiological agents were used in every
case, including 7 (46.67%) platelet-rich plasma, 5 (33.33%) demineralized bone matrix
combined with platelet-rich plasma, 2 (13.33%) platelet-rich plasma combined with
an implantable electrical bone growth stimulator, and 1 (6.67%) demineralized bone
matrix only. One (6.67%) patient developed a nonunion with collapse of the allogeneic
graft, requiring revision with autogenous iliac crest bone graft. There were 8 (53.33%)
minor complications, including 4 (26.66%) cases with inferior heel irritation, 2 (13.33%)
with sural nerve paresthesia, and 2 (13.33%) with wound dehiscence. In conclusion,
the use of allograft for subtalar joint distraction arthrodesis results in similar
union rates as autogenous iliac crest grafting previously reported in the literature.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: May 12, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
