Primary Subtalar Joint Arthrodesis in The Treatment of Calcaneal Fractures
Primary Subtalar Joint Arthrodesis in The Treatment of Calcaneal Fractures
Primary Subtalar Joint Arthrodesis in The Treatment of Calcaneal Fractures
• No conflicts of interest
Purpose
• Review initial management
• Discuss outcomes
• Factors to consider:
– Degree of injury/comminution
– Skin condition/blister management
– Timing of surgery/edema control
– Concomitant injuries
– Medical comorbidities
• Goals:
– Restore articular surface
– Regain height of the posterior facet
– No varus
– Reduce width
Complications in Calcaneal Fractures
• Used in the acute setting to manage fractures with severe comminution and/or cartilage
damage
– Sanders IV
• Late used to manage post traumatic arthritis, ankle impingement, correct residual
deformity
– Often distraction arthrodesis
• High rate of post traumatic arthritis in intra-articular calcaneal fractures, highest rate is in
Sanders Type IV
• Allows for ORIF and fusion in one stage, eliminating need for return to OR for
management of post traumatic arthritis in patients with more severe injury
• Evaluated:
– Bohler’s angle, Sanders classification, VAS, SF-36, oral analoque scale
• Bohler’s angle <0 deg 10x more likely to undergo fusion than >15 deg
• Collection stopped after 7 years for practicality, did not achieve the 66 patients
they initially calculated would be needed
– Power calculation based on prior trial
• Patients with primary arthrodesis may heal faster and do not require additional
surgery later in time, therefore needs to be considered in this patient population
– Healing based on time to weight bearing in this study: 10 wks ORIF, 6 wks ORIF + arthrodesis
• 17 patients, 17 fractures
– Sanders Type IV; Avg follow up 34 months
• Address
– Height
– Varus
– Width
• Fixate
– Calcaneus
– STJ
14
Surgical Technique
• No touch technique
– K-wire in fibula and talus to retract
flap
15
Surgical Technique
16
Surgical Technique
• Prepare joint
• STJ fixation
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Surgical Technique – Case 1
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Surgical Technique – Case 1
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Surgical Technique – Case 1
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Surgical Technique – Case 1
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Surgical Technique – Case 2
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Surgical Technique – Case 2
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Surgical Technique – Case 2
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Surgical Technique – Case 2
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Conclusion
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