Blair Fusion

Discussion

• 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;
  • ICBG 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.