Comparative study of subtalar arthrodesis after calcaneal frature malunion with autologous bone graft or freeze-dried xenograft

Abstract

BackgroundCalcaneal fracture malunion may evolve into arthrosis and severe foot deformities. The aim of this study was to identify differences in bony union following corrective subtalar arthrodesis with interposition of autologous tricortical bone graft or freeze-dried bovine xenograft.MethodsWe prospectively evaluated 12 patients who underwent subtalar arthrodesis, six patients received autografts and 6 received freeze-dried bovine xenografts. After a mean followup of 58 weeks, the patients were clinical assessed using AOFAS scale and the visual analog scale (VAS) for pain and for final radiographic parameters measurement. Two blind raters evaluated the length of time required for solid union of the arthrodesis and graft integration by retrospective radiographic examination.ResultsIn the autograft group, AOFAS score improved from a preoperative average of 37 to 64 points postoperatively (p = 0.02) and mean VAS score improved from 4.7 to 1.9 (p = 0.028). In the xenograft group, AOFAS score improved from 38 to 74 points (p = 0.02) and VAS from 5.5 to 2.7 (p = 0.046). Solid union was achieved in all cases in the autograft group at an average of 5.3 weeks and in five cases in the xenograft group at 8.8 weeks (p = 0.077). Graft integration occurred after an average of 10.7 weeks in the autograft group and 28.8 weeks in the xenograft group (p = 0.016).ConclusionWith the numbers available, no significant difference could be detected in the length of time required for solid union of subtalar arthrodesis between groups, although time to integration of freeze-dried bovine xenografts was statistically higher. Clinical and functional improvement was observed in both groups.

Systematic Review of Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis

“…Figure 2 depicts this selection process. Considering all 25 articles included in the review, none of the studies could be classified as Level I or II according to the system described by Wright et al 33 Two studies could be classified as Level III, 19,29 leaving the remaining 23 as Level IV. Data from all 25 studies were included in the demographic and statistical analyses for a total of 492 subtalar distraction arthrodesis in 467 patients.…”

Biology of Bone Graft and the Use of Bovine Bone for Revision of Total Hip Arthroplasty with Acetabular Reconstruction

“…It provides structural support, osteoconduction and a high content of calcium and phosphorus; essential factors for the newly formed bone tissue [40]. For these reasons, its use is growing in orthopaedic surgeries as reported by Prof. Galia [14] and by his co-workers in his research group, Rosito et al [45,46], Henning et al [23] and Diesel et al [9].…”

Treatment of Malunited Calcaneal Fracture With Posttraumatic Subtalar Osteoarthritis Using Lateral Endoscopic Calcaneoplasty With Posterior Arthroscopic Subtalar Arthrodesis

“…It may develop into posttraumatic subtalar osteoarthritis and severe foot deformities. 1 Late complications of malunited calcaneal fracture involve widening of the calcaneus or lateral calcaneal wall prominence, which may lead to changes in the peroneal tendons, shoe wear difficulties, and often varus deformity of the calcaneus. 1 Appropriate management of complications associated with calcaneus fractures is crucial for comprehensive care of this injury.…”

“… 1 Late complications of malunited calcaneal fracture involve widening of the calcaneus or lateral calcaneal wall prominence, which may lead to changes in the peroneal tendons, shoe wear difficulties, and often varus deformity of the calcaneus. 1 Appropriate management of complications associated with calcaneus fractures is crucial for comprehensive care of this injury. 2 Several authors have described subtalar arthrodesis with bone graft block interposition in the treatment of posttraumatic osteoarthritis along with lateral calcaneal wall prominence resection to correct deformities and hindfoot malalignment with good clinical and radiographic outcomes.…”

“… 2 Several authors have described subtalar arthrodesis with bone graft block interposition in the treatment of posttraumatic osteoarthritis along with lateral calcaneal wall prominence resection to correct deformities and hindfoot malalignment with good clinical and radiographic outcomes. 1 , 3 However, soft tissue compromise is as much a critical concern with a traditional approach as with a lateral extensile approach. Soft tissue infection may occur more frequently following this approach than with minimally invasive surgery.…”