Isolated subtalar arthrodesis after fractures of the calcaneus

Abstract

Background Involvement of the subtalar joint in fracture calcaneus may give rise to chronic pain and permanent functional impairment. This can be produced by subtalar incongruity with calcaneofibular abutment and/or impingement of the tendon, nerve, or other soft tissue. Patients and methods Twenty patients (16 males and four females) underwent subtalar arthrodesis for the treatment of subtalar arthrosis after calcaneal fracture. All patients were initially treated conservatively; the mean time for fusion operation was 20 months (range: 12–36 months). The indications for operation were severe pain and disability in an incongruent subtalar joint with lateral impingement after failed conservative treatment. The fusion was fixed by using cannulated screws in all cases. Results All patients studied at the time of follow-up had a solidly fused subtalar arthrodesis. Two cases had a superficial wound infection and were treated with antibiotics. The mean postoperative period of recovery after which the patient could return to work or daily activities was 9 months (range: 6–12 months). In 16 (80%) patients, there was some residual pain; only four (20%) had no complaints. The result assessments with respect to the American Orthopedic Foot and Ankle Society score showed four (20%) patients with excellent score, good in 10 (50%), fair in four (20%), and poor in two (10%). There was no correlation between the type of accident, the weight of the patient, the recovery period, and the outcome of the American Orthopedic Foot and Ankle Society. Conclusion Isolated subtalar arthrodesis with screw fixation is an effective surgical intervention with significant clinical improvements in some patients with post-traumatic arthrosis of the subtalar joint.