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