Versteifungseingriffe am unteren Sprunggelenk - wechselnde Konzepte im Wandel der Zeit

Abstract

Triple arthrodesis respects the functional unit of the subtalar joint, but shows several intraoperative difficulties such as surfaces of resection that are too large or wrong positions between the hind and the middle foot. Furthermore postoperative problems like walking on uneven pavements, a reduced range of motion in the adjacent joints and the development of osteoarthritis of the ankle are not easy to deal with. Therefore isolated fusions of the talocalcaneal, talonavicular and calcaneo-cuboidal joint with a minimal resection technique seem to present several advantages. Among them we would mention a minimal reduction of the range of motion, the preservation of a physiological position of the adjacent joints and the prevention of osteoarthritis in the adjacent joint which rarely appears and when it does only in an asymptomatic form. The subtalar implants and the astragaloplasty as possibilities to treat disorders of the subtalar joint complex are also discussed.

Subtalar Fusion Preparation: What Are We Really Doing? A Cadaver Study

“…However, literature still cites the correlation between extent of joint preparation and union as a concern. 17 In a case series of 65 patients, Vila-Rico et al 18 found a nonunion rate of 4.6% among patients undergoing arthroscopic subtalar arthrodesis, and noted that open approaches are often utilized to ensure maximal joint preparation due to fear of nonunion. 17 Similarly, Carr et al cited debridement to subchondral bone as a possible contributor to union among patients undergoing posterior arthroscopic subtalar arthrodesis.…”

“…17 In a case series of 65 patients, Vila-Rico et al 18 found a nonunion rate of 4.6% among patients undergoing arthroscopic subtalar arthrodesis, and noted that open approaches are often utilized to ensure maximal joint preparation due to fear of nonunion. 17 Similarly, Carr et al cited debridement to subchondral bone as a possible contributor to union among patients undergoing posterior arthroscopic subtalar arthrodesis. 19 Although clinical outcomes of subtalar arthrodesis have been studied, this is the first study to provide objective quantitative measurements of the extent to which the subtalar joint is prepared in this procedure using the lateral sinus tarsi approach.…”