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Primary Subtalar Fusion for Calcaneal Fracture

- See: sub-talar 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 AF Infante 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;
           - the 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, the 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 the 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;
           - found open reconstruction of the calcaneus with primary fusion of the subtalar joint may be indicated in selected patients and, in these 6 patients led to good results

Primary subtalar arthrodesis of calcaneal fractures.