Subtalar Distraction Arthrodesis Using Interpositional Frozen Structural Allograft

Abstract

Level IV, prospective case series.

Posterior Approach for Subtalar Joint Distraction Arthrodesis by Compact External Fixation: A Technique Guide

“…All 6 patients achieved successful fusion (3). In 2008, Garras et al (8) reported satisfactory results with the posterolateral approach for subtalar joint distraction arthrodesis using a structural graft. The average increase in the American Orthopaedic Foot and Ankle Society scores was 50 points, and the fusion rate was 90% (8).…”

Subtalar Bone Block Distraction Arthrodesis

“…19 The use of a structural autograft in subtalar arthrodesis introduces significant donor site morbidity, greater blood loss, and higher hospital costs. 8,20,21 Garras et al 16 …”

“…They felt that the anatomy of the neck portion of the femoral head allograft is ideally suited for this procedure. 16 Although distraction bone block fusion attempts to restore hindfoot alignment through correction of talocalcaneal height and talar inclination, the need to fully correct these parameters is controversial. Chandler et al 1 conducted a retrospective review of 19 in situ subtalar fusions performed for late sequelae of calcaneal fractures; no significant association between patient outcome and talar declination or talar height was found.…”

“…They felt that the greater surface area of the double graft helps prevent loss of heel height correction. Garras et al 16 in 2008 reported the use of femoral neck allograft and the technique that I currently use for subtalar bone block distraction arthrodesis.…”

Allografts in Foot and Ankle Surgery

“…Although there were a limited number of nonunions in that study, the prevalence of delayed union was high; the authors contended that this finding was a result of the patients being from a relatively high-risk population rather than a factor inherent to the structural allograft as the literature has shown similar success rates with structural autograft harvested from the iliac crest in these complex cases 23 . Garras et al 24 reported on a consecutive prospective series of twenty-two patients (twenty-four feet) who underwent subtalar bone-block arthrodesis with interpositional frozen femoral head structural allograft. The cohort comprised patients with subtalar arthritis, considerable hindfoot collapse, loss of heel height, and symptomatic anterior ankle impingement.…”