Distraction subtalar arthrodesis for calcaneal malunion

Abstract

Aims We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602.

Lipoteichoic Acid Accelerates Bone Healing by Enhancing Osteoblast Differentiation and Inhibiting Osteoclast Activation in a Mouse Model of Femoral Defects

“…Harvesting and transplanting autogenous bone from the iliac crest is the gold standard for supporting bone healing in non-unions. However, limited autografts are available and are accompanied with high risks during harvest for wound infection and postoperative pain [ 7 ]. Allogenic bone grafts provide a relatively safe alternative over autografts, which have donor-site disadvantages due to their processing in terms of sterilization and storage, which in turn causes losses of osteogenic and osteoinductive capabilities [ 8 ].…”

Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study

“…On the one hand, when Trnka et al [ 16 ] used allograft bone, 4/5 patients developed nonunion at the fusion site. On the other hand, taking the iliac bone or a medial tibial bone graft increases the secondary trauma, causing pain in the donor site in as high as 29% to 38% of the patients [ 17 ]. Myerson et al [ 18 ] pointed out that Carr et al had poor results in 7 out of 14 cases after fusion, mainly due to the decrease in the calcaneal height caused by bone graft resorption.…”

Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

“…As previously mentioned, there are various options regarding the operative treatment of calcaneal malunion-from relatively simple in situ arthrodesis to more complex combinations with distraction blocks (using different types of transplants and materials) and calcaneal osteotomies for reconstruction of hindfoot anatomy. 7,15,17,20 Although many original studies, as well as metareviews, have been published annually regarding different aspects of the topic, there is some controversy surrounding the effectiveness of in situ arthrodesis. In 2007, Savva and Saxby 22 reported that in situ arthrodesis combined with lateral wall resection can yield good results, regardless of the loss of talocalcaneal height.…”