- See: subtalar arthrodesis
- Primary Fusion:
- indicated for fractures w/ more than 3 parts;
- restores length of gastrocnemius-soleus complex
- corrects flat foot
- relieves the narrow peroneal space;
- in the presentation by Infante AF, et al (15th Annual Meeting of the Orthopaedic Trauma Association 1999), the authors advocate immediate
subtalar fusion for comminuted (Sanders IV) calcaneal fractures;
- 30 patients that received immediate subtalar fusion were available for review;
- 28 of these fractures went on to fusion by 4 months;
- authors point out that primary fusion is easier than delayed fusion because the soft tissues around the fracture site are scarred and shortened,
and the normal anatomy must be restored;
- they advise against the wait and see attitude since this often causes the patient upto 6 months of pain and lost wages, where as with fusion,
patient may move on their life;
- in the report by Huefner T, et al.
, the authors retrospectively evaluated the long-term results of isolated calcaneal fractures treated with open
reduction and internal fixation and a primary subtalar arthrodesis;
- from 1990 to 1997 258 patients were treated with a calcaneal fracture, for the current study six patients were included;
- indication for the fusion was based on the comminution of the posterior facet according to the preoperative CT as well as intraoperative
evaluation of destruction of the cartilage;
- restoration of length, axes and angles of the calcaneus was almost anatomical in all cases;
- follow-up was done at a mean of 4.9 (2.5 - 7.5 years).
- using the AOFAS score, the results were good or excellent in five patients;
- all returned to their profession within 9 months and had no or only minor daily restrictions;
- open reconstruction of calcaneus with primary fusion of subtalar joint may be indicated in selected patients and, in these 6 patients
led to good results;
- reference: Primary subtalar arthrodesis of calcaneal fractures.
- Technique Considerations:
- type-I malunions: perform lateral wall exostectomy and peroneal tenolysis;
- type-II malunions: perform lateral wall exostectomy, peroneal tenolysis, and subtalar bone-block arthrodesis;
- type-III malunions: perform lateral wall exostectomy, peroneal tenolysis, subtalar bone-block arthrodesis, and a calcaneal osteotomy;
- Technical Pitfalls:
with calcaneal malunion, there is:
- depression of the posterior facet of the subtalar joint
- dorsiflexion of the talus (due to diminished height posteriorly), which can cause impingement against anterior tibia;
- look at Boehler's angle
for evidence of malunion
Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions.
Outcome of subtalar arthrodesis after calcaneal fracture.
Primary subtalar arthrodesis of calcaneal fractures.
Subtalar arthrodesis for complications of intra-articular calcaneal fractures.
Long-term results of subtalar fusions after operative versus nonoperative treatment of os calcis fractures.
In situ arthrodesis with lateral-wall ostectomy for the sequelae of fracture of the os calcis
Foot function after subtalar distraction bone-block arthrodesis: a prospective study
Subtalar distraction arthrodesis using interpositional frozen structural allograft
Subtalar distraction bone block arthrodesis
Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures.
Subtalar Fusion After Displaced Intra-Articular Calcaneal Fractures: Does Initial Operative Treatment Matter?
Primary fusion in worker's compensation intraarticular calcaneus fracture. Prospective study of 169 consecutive cases.
ORIF vs ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures: A Randomized Multicenter Trial.
Original Text by Clifford R. Wheeless, III, MD.