- 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.
Original Text by Clifford R. Wheeless, III, MD.