SLR - July 2011 - Betty Carreira
Reference: Eid, M., El-Soud, M., Mahran, M., El- Hussieni, T. (2010). Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft. Strat Traum Limb Recon, 5: 39-45
Scientific Literature Review
Reviewed by: Betty Carreira, DPM
Residency Program: Roxborough Memorial Hospital
Podiatric Relevance:
The article presents a percuntaneous subtalar arthrodesis technique using autogenous posterior iliac graft with no fixation and immediate partial weightbearing in the treatment of subtalar joint arthritis following neglected, malreduced calcaneal fracture.
Methods:
Sixteen patients underwent the percuntaneous subtalar arthrodesis with posterior iliac bone graft between 2004 and 2006. The percutaneous posterolateral approach consisted of 3 cm vertical incision between the lateral malleolus and Achilles tendon. Conventional dynamic hip screw insertion instruments and reamers were used to create a fusion tunnel transversing the joint from posterior to anterior. Correction of hindfoot varus or valgus was possible by altering the tunnel placement. The autograft was harvested and impacted into the tunnel; no fixation was necessary. Patients were partial weight-bearing in cast boot for 2 weeks with crutches following by full weight-bearing for 6 weeks.
Results:
Mean patient follow-up period was 40.8 months. The average clinical rating scale based on the American Orthopaedic Foot and Ankle Society (AOFAS) improved from 36 preoperatively to 78 postoperatively. Radiographic union rate was 94% with a mean increase in calcaneal inclination of 6.25◦ and mean increase in lateral talocalacaneal angle of 7.42◦. Complications included graft nonunion in 1 patient and transient Achilles tendonitis in another patient.
Conclusions:
The authors’ percuntaneous subtalar arthrodesis with posterior iliac bone graft technique offers a simple, less traumatic and less time consuming approach for the correction of hindfoot deformity in neglected, malreduced calcaneal fractures. Excellent clinical and radiographic results can be achieved with this technique which allows for immediate weightbearing and avoids hardware related complications.