title: Guided tissue regeneration with heterologous materials in primary subtalar arthrodesis: a case report.
abstract: BACKGROUND
  Calcaneal fractures are relatively rare and difficult to treat. Treatment options vary based on the type of fracture and the surgeon's experiences. In recent years, surgical procedures have increasingly been used due to the better long-term results. We present a case where guided tissue regeneration was performed in a calcaneal fracture that needed primary subtalar arthrodesis. We used the principles of guided tissue regeneration from oral surgery to perform primary subtalar arthrodesis and minimize the risk of non-union. We used a heterologous collagen membrane, which acts as a mechanical barrier and protects the bone graft from the invasion of unwanted cells that could lead to non-union. The collagenous membrane also has osteoconductive properties and is therefore able to increase the osteoblast proliferation rate.
  
  
  METHODS
  A 62-year-old Caucasian woman sustained multiple fractures of her lower limbs and spine after a fall from a ladder. Her left calcaneus had a comminuted multifragmental fracture (Sanders type IV) with severe destruction of the cartilage of her subtalar joint and depression of the Böhler's angle. Therefore, we performed primary arthrodesis of her subtalar joint with elevation of the Böhler's angle using a 7.3 mm titanium screw, a heterologous cortico-cancellous collagenated pre-hydrated bone mix, a heterologous cancellous collagenated bone wedge, and a heterologous collagen membrane (Tecnoss®, Italy). The graft was fully incorporated 12 weeks after the procedure and a year and a half later our patient walks without limping. We present a new use of guided tissue regeneration with heterologous materials that can be used to treat extensive bone defects after bone injuries.
  
  
  CONCLUSIONS
  We believe that guided tissue regeneration using heterologous materials, including a heterologous collagen membrane that presents a mechanical barrier between soft tissues and bone as well as a stimulative component that enhances bone formation, could be more often used in bone surgery.
authors.affiliation: Department of Traumatology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia. ifrangez@gmail.com.
authors.forename: Igor
authors.initials: I
authors.lastname: Frangez
authors.affiliation: Medical Faculty of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
authors.forename: Tea
authors.initials: T
authors.lastname: Kasnik
authors.affiliation: Department of Traumatology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
authors.forename: Matej
authors.initials: M
authors.lastname: Cimerman
authors.affiliation: Department of Traumatology, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.
authors.forename: Dragica Maja
authors.initials: DM
authors.lastname: Smrke
mesh_terms: D000058:Accidental Falls; D001174:Arthrodesis / Q000379:methods*; D001861:Bone Regeneration; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000293:injuries / Q000601:surgery*; D003094:Collagen; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery*; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013380:Subtalar Joint / Q000293:injuries / Q000601:surgery*; D014183:Transplantation, Heterologous
chemical_list: D003094:Collagen
keywords: Guided tissue regeneration; Heterologous bone graft; Heterologous collagen membrane; Subtalar arthrodesis