- in those cases in which inadequate bone remains, salvage of ankle joint may be brought about by realignment of tibiotalar joint & fusion of subtalar joint
or by tibiocalcaneal fusion w/ tricortical bone graft.
- this fusion has been used to salvage cases of avascular collapse w/ degenerative changes in the ankle and subtalar joint
- most frequent indication, is salvage of AVN due to talar neck frx
- use of this procedure is limited to those pts w/ adequate remaining talar neck to receive the tibial graft.
- advantages: maintains relatively normal appearance to the foot, w/ maintenance of alignment, minimizing shortening, and maximizing the remaining subtalar complex range of motion;
- Surgical Technique:
- performed through anterolateral approach
- talar body is discarded;
- the foot is placed in 10-15 deg of equinus;
- sliding bone graft from anterior aspect of tibia is inserted into talar neck to reestablish limb continuity while maintaining some hindfoot motion;
is also used to augment fusion;
- fixation is augmented by a posterior tibial cancellous screw into the talar head
Blair tibiotalar arthrodesis for injuries to the talus
Functional outcome after modified Blair tibiotalar arthrodesis for talar osteonecrosis.