Shaped titanium wedges for subtalar distraction arthrodesis: Early clinical and radiological results

BackgroundDisplaced intraarticular calcaneum fractures are associated with late symptomatic hind foot malalignment and painful arthrosis for which distraction subtalar fusion might be considered. During subtalar distraction arthrodesis, a structural graft is often used to fill gaps. Autograft, the current gold standard, is limited in availabilityand is associated with donor-site morbidity and collapse. Allografts have the risk of infectious disease transmission, rejection and failure to integrate. The clinical outcomes and midterm results of subtalar distraction arthrodesis with biofoamtitanium wedges are presented.MethodsA review of 4 patients (3 male and 1 female) undergoing subtalar bone block distraction arthrodesis using biofoam titanium wedges is reported. Results were evaluated clinically and radiologically Mean time from trauma to surgery was 27.5 months and mean follow up was 12 months.ResultsThe mean FAAM ADL score improved from 31.4% preoperatively to 74.2% postoperatively and mean AOFAS score improved from 23.4 preoperatively to 69.6 postoperatively.There was improvement in all radiographic parameters, with 44% improvement in calcaneal pitch, 23% improvement in talocalcaneal angle, 21% increase in talus-first metatarsal angle, and 13.5% correction of talocalcaneal height. VAS Pain scores wasimproved from a pre-operative mean of 8 to a post-operative mean of 2. Mean time to fusion was 13 weeks. Union was achieved in all cases.ConclusionOur data suggest titanium wedges may be used as a structural graft option for subtalar bone block distraction arthrodesis. Fusion rates and time to incorporation are comparable to autogenous bone graft without the associated morbidity.Level IV Case Series.