Subtalar fusion with iliac bone free flap after a recalcitrant nonunion: Report of two cases

Abstract

Fractures of the calcaneus are associated with secondary osteoarthritis of the subtalar joint. In a persistent nonunion, vascularized bone flaps offer superior biologic and mechanical properties as well as accelerates joint fusion and decreases morbidity. In this report, we present results of the use of vascularized iliac bone free flap for treating subtalar failed fusions in two patients. Two patients sustained calcaneal fractures due to foot trauma, which were initially or subsequently treated with subtalar arthrodesis. Case one developed septic subtalar nonunion during treatment and case two failed three attempts at subtalar arthrodeses. The iliac crest bone flap harvested measured 4 × 4 cm (case one) and 3 × 3 cm (case two). The flap was pedicled by the deep circumflex iliac artery, which was anastomosed to the anterior tibial artery at the recipient site. No flap donor or recipient site complications occurred. Fusion was confirmed on CT scan and weight bearing was initiated at 5-6 months. At latest follow up (1-2 years), no complications occurred. Our results show that subtalar nonunion treatment with a vascularized iliac bone flap may be feasible and such a reconstruction could be clinically successful. © 2015 Wiley Periodicals, Inc. Microsurgery 36:501-506, 2016.

Minimally invasive subtalar arthrodesis for traumatic subtalar arthritis

“…14 For patients with subtalar nonunions, some experts have used an iliac bone free flap to realize radiographic bony union with no recurrence of infection or wound healing problems. 15 Niedhart et al. 16 reported that an autogenous iliac graft was the gold standard clinical bone graft for subtalar joint fusion but that it may lead to donor site complications.…”

“…14 For patients with subtalar nonunions, some experts have used an iliac bone free flap to realize radiographic bony union with no recurrence of infection or wound healing problems. 15 Niedhart et al 16 reported that an autogenous iliac graft was the gold standard clinical bone graft for subtalar joint fusion but that it may lead to donor site complications. Whether by traditional surgery, arthroscopic surgery, or other methods of minimally invasive surgery, most patients underwent autogenous iliac grafting procedures that increased the trauma, intraoperative bleeding, and risk of complications.…”

Role of Free Iliac Crest Flap in Foot and Ankle Reconstruction

“…The iliac crest has been proven to provide bone material up to 24 cm in length and 4 cm in width, being superior compared with the fibula. 31,32 However, vascularized bone grafts over 12 cm in size should not be raised due to the increased risk of donor-site stress fractures. 33 In the present series, the widest graft was 4.5 cm in size, whereas the maximum graft length was 10 cm.…”

Subtalar arthrodesis with bone graft. Is it needed for smokers?

“…O tabagismo, além de ser reconhecido como um dos maiores problemas econômicos de saúde pública no mundo, possui efeitos negativos reconhecidos em diversos resultados pós-cirúrgicos, como complicações com ferida operatória, maiores taxas de não consolidação e piores resultados em artroplastias (6)(7)(8)(9) . O enxerto ósseo é um componente importante das artrodeses do pé e tornozelo, tendo sido muito utilizado nas décadas finais do século passado, não sendo necessário na ausência de fatores complicadores (10) . É utilizado como osteoindutor e para melhorar o potencial osteogênico em condições em que, sabidamente, o sistema biológico não é favorável, em cirurgias de revisão após a não fusão e quando permanece um grande defeito estrutural após a cruentização da articulação (11) .…”