SLR - September 2011 - Jill Greenley
Reference: Eid, M., El-Soud, M., Mahran, M., El-Hussieni, T. (2010). Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft. Strategies in Trauma and Limb Reconstruction, 5, 39-45.
Scientific Literature Review
Reviewed by: Jill Greenley, DPM
Residency Program: St. John Hospital and Medical Center, Detroit, MI.
Podiatric Relevance:
Symptomatic, post-traumatic subtalar joint arthritis is frequently managed by performing a subtalar joint arthrodesis. This article details a minimally invasive technique for subtalar joint arthrodesis without the use of internal fixatives and allows immediate post-operative weight bearing.
Methods:
Sixteen patients with post-calcaneal fracture subtalar joint arthritis were involved in this study. The subtalar joint was accessed through a posterior lateral incision between the lateral malleolus and Achilles tendon. An 8mm conventional dynamic hip screw reamer was utilized to create channel through the subtalar joint oriented posterior to anterior. A previously harvested posterior iliac crest autograft was then impacted into the channel traversing the subtalar joint. Immediate weight bearing was allowed in a cast boot on the second post operative day.
Results:
Radiographic and clinical evaluation were performed to evaluate the success of the arthrodesis. Clinical evaluation was performed utilizing the ankle-hindfoot scale of the AOFAS. Of the sixteen patients, no patient reported severe or constant pain, and twelve had no daily or recreational functional limitation. None of the patients displayed instability upon examination. Fifteen patients achieved radiographic union; the one patient with radiographic nonunion achieved a good AOFAS score. Complications included talonavicular arthritis, Achilles tendonitis, and radiographic nonunion at the talar-graft interface.
Conclusions:
This article presents a non-traditional technique for subtalar joint arthrodesis. This protocol highlights the advantage of immediate weight bearing subsequent to a minimally invasive surgical technique. A 94% union rate was achieved without the use of internal or external fixation which reduced risk of infection associated with fixation. Decreased operating room time and radiation exposure were also observed. This straightforward technique should be considered for patients with subtalar joint arthritis secondary to calcaneal fracture.