Aim of the work
Theaim of this study was to evaluate the results of subtalar distraction bone-block fusion for the management of subtalar arthritis due to malunited calcaneal fractures.
Patients and methods
Subtalar distraction bone-block fusion was performed for the management of malunited calcaneal fractures in 20 patients (20 feet) between May 2006 and December 2009 at the Orthopedic Department, Faculty of Medicine, Zagazig University. The mean age of the patients was 30 years. Patients included 15 men and five women. Each patient completed a standardized questionnaire, based on the hindfoot-scoring system of the American Orthopedic Foot and Ankle Society, which was reviewed both clinically and radiologically. No staples or screws were used for fixation of the graft taken from the iliac bone.
Results
All patients showed solid fusion at the end of follow-up. The mean hindfoot score (maximum of 94 points) increased from 22.0 points preoperatively to 75.7 points at the final follow-up. The mean talocalcaneal and calcaneal pitch angles were 22 and 5.2° preoperatively, which improved to 26.2 and 8.0°, respectively, at the final follow-up. The mean talocalcaneal height increased from 65.5 mm before operation to 71.0 mm at the final follow-up. Three patients had sural nerve neuralgia and one patient had superficial infection at the graft donor site.
Conclusion
Subtalar distraction bone-block fusion can be used for the treatment of subtalar arthritis resulting from malunited calcaneal fractures to restore heel height and normal position of the talus, as well as to relieve pain resulting from arthritis, without the use of screws or staples to fix the graft, yielding similar results to those of techniques using screws or staples to fix the graft.