title: Use of a spinal cage for creating stable constructs in ankle and subtalar fusion.
abstract: In complicated foot surgery with reconstruction of the hindfoot, a gap will sometimes be present between the bones that must be filled and stabilized. Bone grafting with structural bone graft is 1 alternative; however, it can collapse and must be stabilized with screws or a nail. A locking intramedullary nail can be used but could lead to nonunion owing to distraction. Newer nails include a compression device but that can result in shortening. We developed a technique that includes distraction of the fusion area with a spinal cage and then compression of the construct by inserting a compression screw through the cage. We present our experience with this technique.We reviewed the data from 7 patients who had undergone surgery using this technique. The technique included distraction of the fusion area and insertion of a titanium cylindrical spinal cage filled with autologous cancellous bone graft. A cannulated compression screw was then inserted through the cage, creating compression of the fusion area against the cage and achieving stabilization of the fusion area. Postoperatively, a non-weightbearing cast was applied for 3 months, followed by a full weightbearing cast until radiographic fusion was apparent. Complete radiographic union was observed in all 7 patients within 6 to 12 months postoperatively. At the latest follow-up visit, the mean American Orthopaedic Foot and Ankle Society scale score was 54 ± 16 (range 30 to 71) points. The use of a cylindrical titanium cage with a local bone graft and stabilization by distraction and compression provided a stable construct, avoided shortening, and led to good fusion. In addition, donor site complications and unpredictable strength loss and lysis of bone allograft were avoided.
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel. Electronic address: ezepalm@gmail.com.
authors: Ezequiel
authors: E
authors: Palmanovich
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Yaron S
authors: YS
authors: Brin
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Dror
authors: D
authors: Ben David
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Sabri
authors: S
authors: Massarwe
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Abraham
authors: A
authors: Stern
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Meir
authors: M
authors: Nyska
authors: Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
authors: Iftach
authors: I
authors: Hetsroni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D016025:Bone Transplantation / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007592:Joint Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013380:Subtalar Joint; D016896:Treatment Outcome
keywords: bone grafting; compression distraction; hindfoot fusion; nonunion