Subtalar distractional realignment arthrodesis with wedge bone grafting and lateral decompression for calcaneal malunion.
BACKGROUND
The purpose of this study was to evaluate prospectively the efficacy of subtalar distractional realignment arthrodesis in the treatment of calcaneal malunion associated with subtalar arthritis, collapse of height, talonavicular subluxation, malalignment of the heel axis, and widening heel with calcaneofibular abutment.


METHODS
Thirty-four patients with severe calcaneal malunion were treated with a lateral approach, lateral decompression, medial subtalar capsulotomy, and distraction and realignment of the subtalar joint with an anteriorly and laterally tapered wedge bone graft. The patients were evaluated with a functional rating scale and radiographs, both before and after surgery.


RESULTS
Thirty-two of the 34 patients were evaluated at a mean of 71 months (range, 60-92 months) after the arthrodesis. Solid subtalar fusion was achieved in 31 of the 32 patients. The average gain of subtalar distraction was 12 mm. Neutral or mild valgus alignment was achieved in 26 of the 32 patients. The mean postoperative score (83) showed significant improvement over the mean preoperative score (47). Overall, the functional rating scale revealed excellent or good results in 26 patients and fair results in 6 patients.


CONCLUSIONS
Coupled with wedge bone grafting, the subtalar distractional realignment arthrodesis achieved restoration of hindfoot height and axial alignment with a good union rate and significant improvement in the majority of patients with calcaneal malunion.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Y J
YJ
Chen
T J
TJ
Huang
K Y
KY
Hsu
R W
RW
Hsu
C W
CW
Chen
D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D016025:Bone Transplantation; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery; D017759:Fractures, Malunited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome