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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/ ┬átricortical bone graft.
  • this fusion has been used to salvage cases of avascular collapse w/ degenerative changes in the ankle and subtalar joint;
  • 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