Reconstruction of calcaneal thalamus and subtalar arthrodesis for severe malunion of calcaneal fractures
- VernacularTitle:跟骨丘部重建距下关节融合治疗跟骨骨折严重畸形愈合
- Author:
Guangrong YU
;
Jiong MEI
;
Hui ZHU
- Publication Type:Journal Article
- Keywords:
Calcaneus;
Fractures;
Fracture healing;
Abnormalities
- From:
Chinese Journal of Orthopaedics
2001;0(01):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To introduce the reconstruction of calcaneal thalamus by bone autograft and subtalar arthrodesis for severe deformities caused by malunion of calcaneal fractures and to discuss the indications and its advantages of the management. Methods From November 1998 to August 2002, 17 cases with 21 malunited calcaneal fractures were treated, which were 13 males and 4 females with an average age of 35.4 years( 25 to 45 years). Unilateral calcaneus was involved in 13 cases, and bilateral calcaneus was affected in 4 cases. The primary treatment was manipulation and immobilization with a cast in all patients. The interval from injury to the operation was on an average of 33.6 months(7 to 50.4 months). The common complaints were painful heels and walking difficulty. Furthermore, there was subluxation of talonavicular joint in 5 cases, protruded osteophyte and fragment from the lateral wall of calcaneus in 12 cases. Lateral, axial, and oblique roentgenograms were taken preoperatively, and three dimensional reconstruction of CT scan as well. Results The modified extended L-shaped approach lateral to calcaneus was used. The bulging lateral wall of calcaneus was excised and reserved for reconstruction of calcaneal thalamus if possible. While in some cases the bone autograft had to be harvested from iliac crest if the excised lateral wall was not available. After the cartilage of subtalar joint was removed completely, the calcaneal thalamus was reconstructed with the bone and fixed with 2 to 3 screws, the contour and position of calcaneus was conformed without valgus or varus by "C" arm intensifier. A short leg cast was used for immobilization one month after operation. Among the patients, 18 feet were followed up on an average of 14.5 months (9 to 22 months). The total excellent and good rate was 88.8% according to Maryland foot score system. Plain radiography showed that B hler angle, Gissane angle, talus inclining angle, width of calcaneus and height of calcaneal thalamus were restored to nearly normal. Conclusion The reconstruction of calcaneal thalamus by bone autograft combined with subtalar arthrodesis is an effective operation for severe malunion of calcaneal fractures, which can improve calcaneal abnormality, and make recovery of the shape of hind foot and functions satisfactorily.
