Arthrodesis of the subtalar and talonavicular joints for correction of symptomatic hindfoot malalignment

BACKGROUND: Triple arthrodesis has long been used for the treatment of painful malalignment or arthritis of the hindfoot. However, the effect of fusion on adjacent joints has sparked interest in a more limited arthrodesis in patients without involvement of the calcaneocuboid joint. METHOD: Results of 16 feet in 14 patients who had a modified double arthrodesis for symptomatic flatfoot, cavovarus deformity, or hindfoot arthritis were reviewed retrospectively with a minimum followup of 18 (range 18 to 93) months. The most common diagnosis contributing to the hindfoot deformity was pes planovalgus. All operations were done with a consistent technique using rigid internal fixation with screws. In 15 feet, a concomitant gastrocnemius recession for equinus contracture was done at the time of the primary surgery. Clinical evaluation was based on the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale in addition to subjective assessments of pain, function, shoewear, cosmesis, and overall satisfaction. Radiographic evaluation included measurements of the anterior-posterior talo-second metatarsal angle, lateral talocalcaneal angle, and lateral talo-first metatarsal angle, and notation of arthritic changes of the ankle, calcaneocuboid, and midfoot joints, as well as an assessment of time to union of all arthrodeses. RESULTS: The average AOFAS Ankle-Hindfoot Scale improved from 44.7 preoperatively to 77.0 postoperatively (p < 0.01). Subjectively, patients experienced improvements in pain, function, cosmesis, and shoewear. Overall, all patients were satisfied and would have the procedure again under similar circumstances. Radiographically, all parameters statistically improved. There was an increase in arthritic scores for six ankle, six calcaneocuboid, and five midfoot joints. One talonavicular joint nonunion occurred in a rheumatoid patient, requiring revision arthrodesis. CONCLUSIONS: We have concluded that simultaneous arthrodesis of the talonavicular and subtalar joints is a reasonable treatment in the subset of patients with symptomatic hindfoot malalignment whose calcaneocuboid joints are not involved in the primary disease.     

A Posterior 3-Portal Arthroscopic Approach for Isolated Subtalar Arthrodesis

Arthroscopic subtalar arthrodesis was developed to improve on open methods of fusion. A posterior 3-portal arthroscopic approach with the patient in the prone position provides a new and optimal method for isolated subtalar arthrodesis. It facilitates safe access to the posterior talocalcaneal facet. The posterolateral portal was established using blunt dissection. The 3-mm, 30° arthroscope was inserted, the posterolateral portal was made, and synovectomy carried out. A large 4-mm arthroscope was used to improve fluid flow. The third portal was then established approximately 1 cm proximal and 1 cm posterior to the tip of the lateral malleolus. This portal was used for distraction by inserting a large blunt trocar into the joint. Most of the procedure was performed with the arthroscope in the posterolateral portal and the instruments posteromedial. Allograft was inserted through the posterolateral portal. Fixation was achieved using 2 cannulated 6.5- or 7.3-mm cancellous screws, inserted under fluoroscopic control. Postoperatively, patients were assigned to non-weight bearing cast immobilization with crutch ambulation for 6 weeks, followed by gradual weight bearing until radiographs showed union. Preliminary results have shown high patient satisfaction, an excellent fusion rate, and less postoperative morbidity than with open subtalar arthrodesis.     

Posterior Arthroscopic Subtalar Arthrodesis: Clinical and Radiologic Review of 19 Cases

Arthroscopic subtalar arthrodesis has recently gained popularity in the treatment of primary subtalar or post-traumatic arthritis, coalition, or inflammatory diseases with subtalar arthritis. The present study reports the clinical and radiologic results of 19 patients (19 feet) who underwent posterior arthroscopic subtalar arthrodesis using 2 posterior portals. A total of 19 posterior arthroscopic subtalar arthrodeses (minimum follow-up of 24 months) performed without a bone graft and with 2 parallel screws were prospectively evaluated. The fusion rate was 94% (mean time to fusion 9.8 weeks). Modified American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score (maximum 94 points) improved significantly from 43 to 80 points and the visual analog scale for pain score improved from 7.6 to 1.2. The 12-item short-form physical and mental scores at the last follow-up point were 52.5 and 56.4, respectively. One (5.3%) patient underwent open repeat fusion for nonunion, 2 (10.5%) patients required a second procedure for implant removal, and 1 (5.3%) experienced reversible neuropraxia. In conclusion, posterior arthroscopic subtalar arthrodesis is a safe technique with a good union rate and a small number of complications in patients with no or very little hindfoot deformity.     

Clinical outcome after primary triple arthrodesis

BACKGROUND: To analyze the effects of multiple preoperative, intraoperative, and postoperative factors on the intermediate results of triple arthrodesis, we focused on preoperative deformity, preoperative diagnosis, degree of clinical and radiographic correction, and arthritis of the ankle. METHODS: Between 1987 and 1995, 160 patients were managed with a total of 183 triple arthrodeses. Patients who had an infection or neuroarthropathy or who were managed with a revision arthrodesis were excluded from our study. Of the 160 patients, 111 (132 feet) who had been followed for a minimum of two years formed our study group. Each patient had an arthrodesis with rigid screw fixation and realignment of the joint surfaces without resection of wedges. The average duration of follow-up was 5.7 years (range, 2.0 to 10.8 years). RESULTS: As seen radiographically, arthritis of the ankle was significantly more severe postoperatively than preoperatively (p<0.01), although patient satisfaction was not associated with the presence of arthritis. On a scale (not a visual analog) of 0 (not satisfied) to 10 (completely satisfied), overall satisfaction averaged 8.3 points (range, 0 to 10 points). The postoperative modified ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society averaged 60.7 points (range, 0 to 94 points). There was a significant association (p = 0.001) between satisfaction of the patient and postoperative alignment. Ten patients had a total of eleven complications: four superficial wound problems, three nonunions, one case of superficial peroneal neuritis, one case of Charcot-like neuroarthropathy of the foot (in a patient in whom diabetes developed during the follow-up period), one rupture of the Achilles tendon, and one case of peroneal tenosynovitis. Of the 111 patients, 101 (91 percent) stated that they would have the procedure again under similar circumstances, and this response was independent of the preoperative diagnostic or deformity group. CONCLUSIONS: Triple arthrodesis for the treatment of various deformities and etiologies is effective in relieving pain and improving functional deficits. Although a high prevalence of subsequent arthritis of the ankle was noted clinically and radiographically, we could detect no association between satisfaction of the patient and arthritis.     

跟骨关节内骨折畸形愈合的手术治疗

目的 报告手术治疗跟骨关节内骨折畸形愈合的方法 和疗效. 方法 2003年2月至2007年12月收治并获得随访的跟骨关节内骨折畸形愈合患者49例,按Sanders分型:Ⅰ型6例,Ⅱ型15例,Ⅲ型28例.Ⅰ型行单纯跟骨外侧壁截骨,Ⅱ型根据有无高度丢失行距下关节原位或撑开植骨融合,Ⅲ型需同时行跟骨体部截骨或通过移植髂骨块宽度来纠正内外翻畸形.用多枚空心螺钉固定结合短腿石膏制动,确保关节融合. 结果 49例获得平均18.4个月随访,距下关节融合时间平均12.8周.术后的平均距跟高度、距骨倾斜角、距跟角、跟骨携带角均比术前明显改善.美国足踝外科协会(AOFAS)后足评分从术前的平均25.7±4.3分提高至最后随访时的74.9±4.8分.结论 跟骨关节内骨折畸形愈合的手术治疗应以术前临床和影像学评估为基础,根据患足的畸形和患者的期望值选择个体化方案,进行跟骨外侧减压、矫正后足内外翻畸形并融合距下关节.     

Tibiotalocalcaneal arthrodesis in treatment of hindfoot pain and deformity

BackgroundTibiotalocalcaneal arthrodesis is a salvage procedure for patients with severe disease of the ankle and subtalar joints.MethodsWe report a series of 26 consecutive patients (26 feet) operated on by a single surgeon in a single centre over a 4 year period with average follow up of 26 months (6–50 months). Average age of the patients was 57 years (28–72 years). Patients had combined ankle and subtalar joint arthrodesis by an intramedullary nail device. Indications for surgery were pain except for the Charcot joints. Only five patients did not have severe deformity pre-operatively. Patients were assessed by AOFAS Ankle-Hindfoot Scale, SF-12, patient satisfaction scores and radiologically.ResultsTwo patients have died of unrelated causes. Clinically and radiologically 15 have solid union (65%). Six patients have signs of radiological non-union/delayed union but are clinically asymptomatic. Two patients required amputation. One patient has had revision surgery for infected non-union. Most patients are very satisfied with the procedure (79%) and would undergo the procedure again (83%).ConclusionMajority of cases with combined ankle and subtalar joint arthrosis and severe deformity can be salvaged.     

Arthroscopic release for painful subtalar stiffness after intra-articular fractures of the calcaneum

We describe the surgical technique and results of arthroscopic subtalar release in 17 patients (17 feet) with painful subtalar stiffness following an intra-articular calcaneal fracture of Sanders' type II or III. The mean duration from injury to arthroscopic release was 11.3 months (6.4 to 36) and the mean follow-up after release was 16.8 months (12 to 25). The patient was positioned laterally and three arthroscopic portals were placed anterolaterally, centrally and posterolaterally. The sinus tarsi and lateral gutter were debrided of fibrous tissue and the posterior talocalcaneal facet was released. In all, six patients were very satisfied, eight were satisfied and three were dissatisfied with their results. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from a mean of 49.4 points (35 to 66) pre-operatively to a mean of 79.6 points (51 to 95). All patients reported improvement in movement of the subtalar joint. No complications occurred following operation, but two patients subsequently required subtalar arthrodesis for continuing pain. In the majority of patients a functional improvement in hindfoot function was obtained following arthroscopic release of the subtalar joint for stiffness and pain secondary to Sanders type II and III fractures of the calcaneum.     

Trephine arthrodesis of subtalar joints: operative tech-nique and clinical effect

Objective: To review the operative technique of tre-phine arthrodesis of subtalar joints and evaluate its clinical effect.Methods: From June 1998 to October 2006, we per-formed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.Results: No severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average anlde-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range,1 to 6) post-operatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing.Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Post-operative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavieular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolaterai approach, which required revision arthrodesis.Conclusion: Isolated subtalar arthrodesis with tre-phine method is an effective procedure for painful malalignment of hindfoot.     

手术治疗跟距骨桥疗效观察

目的探讨跟距骨桥的手术治疗方法及疗效。方法 2008年7月-2010年10月,手术治疗跟距骨桥患者10例。男4例,女6例;年龄16～70岁,平均53.5岁。先天性骨桥2例,继发性骨桥8例。跟距中间关节面骨桥3例,后关节面骨桥7例。术前患者疼痛视觉模拟评分(VAS)为(9.0±0.4)分;根据美国矫形足踝协会(AOFAS)后足评分标准为(42.4±1.4)分。合并距下关节退变2例。8例单纯跟距骨桥患者行骨桥切除并脂肪组织植入,2例合并距下关节退变患者行骨桥切除联合距下关节融合术。结果术后切口均Ⅰ期愈合。8例获随访,随访时间12～36个月,平均18个月。末次随访时VAS评分为(2.0±0.7)分,与术前比较差异有统计学意义(t=6.425,P=0.000)。AOFAS后足评分为(86.9±2.3)分,与术前比较差异有统计学意义(t=7.634,P=0.000)。单纯骨桥切除者末次随访时X线片检查示无骨桥复发及关节退变发生,关节融合者X线片示达骨性融合。结论跟距骨桥根据不同发生部位和合并症,分别采用单纯骨桥切除或联合距下关节融合术可取得较好疗效。     

Combined subtalar distraction arthrodesis with peroneus brevis tenotomy for posttraumatic subtalar arthritis

BackgroundSubtalar distraction arthrodesis is advocated as a salvage procedure for isolated posttraumatic subtalar arthritis. This study aimed at evaluating combined subtalar distraction arthrodesis with peroneus brevis tenotomy for such cases.MethodsTwenty patients with isolated posttraumatic subtalar arthritis managed by combined subtalar distraction arthrodesis and peroneus brevis tenotomy were reviewed for a retrospective study. The American orthopaedic foot and ankle society [AOFAS] hindfoot scoring, talocalcaneal height [TCH], talocalcaneal angle [TCA] and heel valgus angle [HVA] were used for both pre and postoperative assessments.ResultsThe mean postoperative [TCH] [70.3 ± 1.9 mm] was statistically better than the preoperative value [64.7 ± 2.2 mm] [p < 0.001]. There was a statistically significant decrease in [HVA] [p < 0.001]. On the contrary, there was a statistically significant increase in both [AOFAS] hindfoot scoring and the [TCA] [p < 0.001].ConclusionsApplying this technique for isolated posttraumatic subtalar arthritis with peroneal tendinitis improved both lateral retromalleolar swelling and deformity correction.     

Posterior talocalcaneal coalition

Tarsal coalition is a rare congenital deformity. The most common coalitions involve the calcaneonavicular joint and the medial facet of the talocalcaneal joint. The posterior facet is rarely involved. We report a case of a patient with a posterior talocalcaneal bar who presented with painful limitation of subtalar motion without the classical appearance of spastic flat foot. Resection of the bar with interposition of fat graft resulted in an almost full range of pain-free subtalar motion.     

Treatment of late recurring idiopathic clubfoot deformity in adults

Late recurrence of idiopathic clubfoot deformity in adults after prior successful surgery in childhood remains a rarity and only case reports exist. No study has yet clarified the results of triple arthrodesis in such cases. Complete clinical and radiological review of 7 patients (7 feet) after a follow-up time of 43 months following triple arthrodesis was undertaken. The time interval between the last surgical intervention and the triple arthrodesis averaged 27 years. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used as an outcome measure. Average age at time of review was 36 years (range 18-45). All patients were examined clinically and radiologically. The AOFAS-score improved from 43 points preoperatively to 61 points at follow-up (p = 0.004). If adjusted by excluding subtalar motion, the relative score improved by 19% (from 46% to 65%; p = 0.0043). Although not significantly altered (p = 0.1), pain scores remained fair (25 points) but were improved compared with the preoperative evaluation (13 points). Ankle motion was not changed. Although statistically not significant, there was an increase in degree of ankle arthritis in 67% of patients (one patient had ankle fusion) and mid- and forefoot degenerative changes in 57%. Hindfoot alignment remained fair after surgical intervention. Triple arthrodesis is a palliative means to correct recurrent deformity in patients with idiopathic clubfoot. Despite residual symptoms and degenerative changes at the ankle, 86% of all patients were satisfied with the postoperative result.     

成人跟距联合术后功能的影响因素分析

背景：成人跟距联合手术治疗方案临床报道较少,术后的功能评估尚不明确。目的：探讨影响成人跟距联合术后功能的相关因素,从而决定更好的手术方案。方法：回顾性研究2011年1月至2013年7月我院收治且获得完整随访资料的24例行跟距联合术的患者资料,男13例,女11例;年龄19~53岁,平均31.5岁。根据术前症状及影像学检查决定手术方案。记录患者年龄、跟距联合分型、跗骨联合的大小、有无距下骨关节炎、后足的外翻角度。应用美国足踝医师协会踝-后足评分表（AOFAS-AH）和踝关节Karlsson-Peterson评分对患者术后的踝关节功能进行评估,并对上述因素进行相关性分析。结果：24例患者获得平均19.5个月的随访（4~33个月）。单纯联合切除术19例,其中4例进行三角韧带修补,1例行外侧韧带重建,1例行跟骨截骨内移术。距下关节融合术5例,其中3例患者仍有疼痛症状。术后的AOFAS评分和Karlsson-Peterson评分均明显改善。经Logistic回归分析,距下关节骨关节炎是术后踝关节功能的影响因素,而跟距联合分型、跗骨联合的大小和后足的外翻角度无明显相关性。结论：距下关节骨关节炎影响跟距联合患者术后的踝关节功能评分,即使行距下关节融合术,在一定程度上也影响患者术后踝关节功能。     

Subtalar arthrodesis with flexor digitorum longus transfer and spring ligament repair for treatment of posterior tibial tendon insufficiency

The surgical treatment of flexible pes planovalgus deformities resulting from Stage 2 posterior tibial tendon insufficiency is controversial and many techniques have been proposed. We retrospectively reviewed the results of subtalar arthrodesis combined with spring ligament repair/reefing and flexor digitorum longus (FDL) transfer to the navicular. There were sixteen patients (seventeen feet) with an average follow-up of 27 months (9-52). All deformities were passively correctable. The average age was 56 yrs (39-78). All patients had failed conservative management, 88% had previously been treated with orthotics, and 53% had lateral pain from subfibular impingement. Two patients were noted to have degenerative changes of the subtalar joint. Successful subtalar joint fusion occurred in all patients with an average time to radiographic union of 10.1 weeks (5-24). The average AOFAS hindfoot score and Maryland foot score postoperatively was 82 and 86 respectively. Standing radiographic analysis demonstrated an average improvement in the AP talo-1st metatarsal angle of 6 degrees (24 degrees preoperative, 18 degrees postoperative). The talonavicular coverage angle improved an average of 17 degrees (34 degrees preoperative, 17 degrees postoperative). The lateral talo-1st metatarsal angle improved an average of 10 degrees (18 degrees preoperative, 8 degrees postoperative). The lateral talocalcaneal angle decreased an average of 21o (55 degrees preoperative, 34 degrees postoperative). The distance of the medial cuneiform to the floor on the lateral radiograph averaged 12mm preoperatively and 18mm postoperatively (avg. improvement 6mm). The combination of the flexor digitorum longus tendon transfer and spring ligament repair with subtalar arthrodesis is an effective and reliable procedure which provides excellent correction of hindfoot valgus as well as forefoot abduction and restoration of the height of the longitudinal arch. These results compare favorably with flexor transfer combined with either calcaneal osteotomy or lateral column lengthening.     

Offene Reposition und Osteosynthese mit primärer subtalarer Arthrodese bei intraartikulärer Kalkaneusfraktur

OBJECTIVE: To prevent the development of painful posttraumatic degenerative joint disease by a primary one-stage procedure to treat calcaneal fractures involving obvious comminution or severe and extensive cartilage damage to the subtalar facet. INDICATIONS: Sanders type IV calcaneal fractures with severe and extensive cartilage destruction. The definitive indication for arthrodesis can only be established intraoperatively. CONTRAINDICATIONS: Severe closed IIIrd or IV nd degree soft-tissue injury according to Tscherne & Oestern. Open fractures. Vascular impairment. Diabetes mellitus. Generalized or local inactivity osteoporosis > grade I according to Kanis. Age > approximately 50 years. SURGICAL TECHNIQUE: Extended lateral approach. Osteosynthesis of the calcaneal fracture, reconstruction of axes, subtalar facet denuded of cartilage, bone graft from the anterior iliac crest, arthrodesis by screw fixation of the subtalar joint. POSTOPERATIVE MANAGEMENT: After edema has subsided, mobilization without a cast and partial loading up to 15 kg for 12 weeks. Clinical and radiologic review after 6 and 12 weeks. RESULTS: This operation is performed very rarely. Within a retrospective study including patients over a period of 14 years (1990-2004), a total of 434 patients with a calcaneal fracture were treated surgically. Primary subtalar arthrodesis was performed in only six of these patients. Healing within 4 months was achieved in all six patients. The clinical and radiologic follow-ups took place on average after 4.9 years (2.5-7.5 years). Radiologically, almost anatomic reconstruction of the axes could be achieved (Gissane and B?hler angles, talometatarsal and talocalcaneal angles, calcaneal length and width). The functional outcomes were also good to very good with an average AOFAS (American Orthopaedic Foot and Ankle Society) Score of 88 points (63-94 points) and a Hanover Score of 84 points (62-90 points).     

Management of complications of tibiotalocalcaneal arthrodesis in patients with co-morbidity

Tibiotalocalcaneal arthrodesis is a viable alternative to amputation in severely deformed hindfoot deformity. We report the results of retrospective analysis of single centre, single surgeon operated consecutive 15 cases of tibiotalocalcaneal arthrodesis at our institution. The diagnosis was rheumatoid arthritis in one case, traumatic arthritis in six, degenerative osteoarthritis in five and neuropathic ankle in three cases. Co-morbidity was seen in 13 cases of which six patients were suffering from diabetes. Bony union was observed in 87% of cases, 85% patients were satisfied at the end result achieved. The aim of this study was to determine improvement in pain, function and to determine patients satisfaction achieved. Considering improvement in pain, function, AOFAS score and patient's satisfaction achieved post-operatively, we feel this is good technique with satisfactory outcome. It provides good biomechanical stability thereby minimising the chances of failure.     

Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome

BACKGROUND: Transfibular ankle arthrodesis with internal fixation and fibular onlay grafting has resulted in acceptable fusion rates. This study analyzed the results of ankle arthrodesis using one operative technique in a large series of patients with high and low risks for nonunions. METHODS: Fifty consecutive patients had a transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting from 1997 to 2004. Two patients were lost to followup. The remaining 48 patients had preoperative and postoperative clinical and radiographic examinations and then were stratified into high-risk and low-risk groups for ankle nonunions. Fifteen of 48 patients were considered at high risk for nonunion. Rate of osseous fusion, satisfaction with the procedure, correction of the deformity, and relief of pain were evaluated. Thirty-five of 48 patients were evaluated with the AOFAS ankle-hindfoot scale at an average 45 months after surgery. RESULTS: Forty-six of 48 patients had bony union (96% union rate). Fourteen of 15 (93%) high-risk patients had bony fusion in an average of 83 days. Thirty-two of 33 patients (97%) in the low-risk group had bony fusion at an average of 81 days. The AOFAS ankle-hindfoot score improved from 38 to 74 in 12 of 15 patients in the high-risk group and from 34 to 69 in 24 of 33 patients in the low-risk group from preoperative to postoperative scores. CONCLUSIONS: A transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting can achieve a high rate of union in both a low-risk and high-risk patient populations. This technique can be an effective approach for most primary and revision cases with or without significant deformity. In addition the AOFAS ankle-hindfoot score improved significantly both in the high-risk and low-risk groups.     

踝关节外侧入路T型接骨板固定在胫距关节融合中的应用

背景:目前踝关节融合仍是治疗踝关节创伤后关节炎的金标准。踝关节融合术后不愈合发生率较高。距骨外后侧坏死者往往难以清理。目的:探讨踝关节外侧入路腓骨下段截骨、胫距关节融合T型接骨板固定治疗踝关节创伤后关节炎的临床疗效。方法:回顾性分析2013年6月至2016年6月采用踝关节外侧入路腓骨截骨、胫距关节融合T型接骨板固定的30例创伤后关节炎患者资料。男18例,女12例,年龄56~75岁,平均67.3岁。根据Morrey-Wiedeman分期,均为3期关节炎。记录患者术后主观满意度,采用美国足踝外科协会(AOFAS)踝功能评分评价末次随访时足踝部功能。结果:30例患者随访时间12~24个月,平均20.0个月。AOFAS评分末次随访时平均为(77.9±6.5)分,与术前(51.2±9.8)分比较,差异有统计学意义(P<0.05)。末次随访时胫距关节均融合,其中1例患者损伤腓肠神经,神经相应支配区出现感觉障碍,经营养神经治疗半年后症状缓解;1例由于早期活动融合处延迟愈合,经石膏固定、口服药物后愈合;1例由于融合时距骨向踝关节前侧稍移位,行走时鞋容易脱落。27例患者对手术效果非常满意,3例一般,满意率为90%。结论:踝关节外侧入路腓骨截骨、胫距关节融合T型接骨板固定治疗创伤后关节炎创伤小,术中获取植骨来源充分,操作方便,伤口风险小,患者术后满意度高,能纠正畸形、缓解疼痛,值得临床推广。     

The results of Grice Green subtalar arthrodesis of valgus foot in spina bifida

Background:

Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft.

Materials and Methods:

Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50–108 months).

Results:

The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05).

Conclusion:

Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.     

Tibiotalocalcaneal (hindfoot) arthrodesis by retrograde intramedullary nailing using a curved locking nail. The results of 52 procedures

BACKGROUND: The purpose of this study was to report the results of 52 combined subtalar and ankle arthrodesis using an intramedullary nail. METHODS: Retrospective review identified 49 patients who had 52 combined ankle and subtalar arthrodeses with an ACE retrograde locked intramedullary humeral nail (DePuy-Ace), Warsaw, IN). Most procedures included bone grafts from the fibula, proximal tibia, or iliac crest or femoral head allograft. Intraoperative complications included one fractured tibia and one fractured medial malleolus. The procedure was done mainly for the treatment of combined ankle and subtalar arthritis (31) or complex hindfoot deformities (12). Outcome was assessed by a combination of chart review, clinical examination, and telephone questionnaire. Followup averaged 34 (8 to 73) months. RESULTS: At followup 82% of patients were satisfied with the results of surgery, 82% reported improvements in pain levels, and 67% reported improved foot function. The average postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 63. Postoperative complications included deep infection, amputation, stress fracture, nonunion, and prominent hardware. CONCLUSION: Hindfoot arthrodesis with intramedullary nailing is an effective technique for treating complex foot deformities and often is the only alternative to amputation. Patient satisfaction is high, but the procedure is demanding and complications are frequent.