Primary Subtalar Arthrodesis for the Treatment of Comminuted Calcaneal Fractures

Abstract

We retrospectively evaluated the results of primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures. Of 108 patients with 112 calcaneal fractures treated at our institution between 1989 and 1992, 16 (15%) underwent primary subtalar arthrodesis through an extensile lateral approach. The calcaneal height and width were restored with standard fixation techniques and then arthrodesis was performed with bone graft and fixation by 7.0-mm cannulated cancellous screws. Fourteen patients (12 males and 2 females; mean age, 40 years) were available for examination at a mean time of 26 months (range, 12-54 months) after surgery. Arthrodesis, evidenced by radiographic bony bridging across the arthrodesis site, was present in all patients between 8 and 12 weeks. Minor wound complications occurred in three patients. Of the 12 patients employed before the injury, 11 returned to their original occupations at a mean time of 8.8 months after injury (range, 1 month to 3 years). The mean AOFAS 100-point clinical rating scale score, evaluating pain, function, and alignment, was 72.4 points (range, 48-88 points). We conclude that primary subtalar arthrodesis is indicated as part of the management of comminuted displaced articular calcaneal fractures, yielding results that allowed 11 of 12 formerly employed patients to return to work.

Controversies in calcaneus fracture management: a systematic review of the literature

“…As a result, open reduction and a primary subtalar arthrodesis have been advocated as a surgical option in the management of badly comminuted intra-articular fractures of calcaneus. Although a few authors described such procedures in the early twentieth century [92][93][94], it is only in the last decade or so when many authors [88,[95][96][97][98] are coming up with proposals of such a surgery in fractures of calcaneus (Table 13). …”

Radiographic evaluation of calcaneal fractures: to measure or not to measure

“…There are two ways of measuring this angle (depending on which line is to be chosen as the calcaneal axis). Some authors use the centre line of the calcaneus as axis [16,19]. Others use the line formed by the most inferior part of the calcaneal tuberosity and the most inferior point of the calcaneocuboid joint [15,17].…”

“…The calcaneal inclination or calcaneal pitch angle (Angle C) is formed by the line connecting the most inferior part of the tuberosity of the calcaneus to the most distal and inferior part of the calcaneus along the calcaneocuboid joint (calcaneal axis) and the plane of support, which is defined by the line connecting the most inferior part of the calcaneal tuberosity with the most inferior part point of the fifth metatarsal head [15][16][17].…”

Results of functional and surgical treatment of thalamic calcaneus fractures: about a retrospective series of 304 cases

“…Les séries de la littérature [10,11,[42][43][44][45][46][47][48][49] retrouvaient dans les arthrodèses secondaires un taux de succès moyen de 68 % (de 33 à 93 %) alors que les séries d'arthrodèses d'emblée [6,[50][51][52][53][54][55][56][57][58][59] avaient un succès moyen de 75 % (de 56 à 100 %…). En pratique, l'évolution de la dégradation arthrosique sous-talienne est multifactorielle et dépend à la fois de la surface atteinte, du cal vicieux post-traumatique, de la raideur articulaire, du valgus ou varus talonnier résiduel.…”