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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/  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.