Subtalar distraction bone block fusion for late complications of os calcis fractures.

Abstract

The authors are presenting a new subtalar fusion technique for late complications of calcaneus fractures. These complications include pain, shoe wear difficulties, and foot deformity. The complex pathology includes incongruous subtalar joint, loss of calcaneal body height, and decreased lateral talocalcaneal angle. The latter two factors can result in tibiotalar neck impingement, a deformity that has received little attention in the literature. The subtalar fusion technique involves distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation. The distraction allows correction of the talocalcaneal relationship and regains lost hindfoot height. The clinical series involved 16 feet with an average follow-up of 19 months. Results were satisfactory in 13 feet. Pre- and postoperative radiographic analysis for tibiotalar impingement, lateral talocalcaneal angle, and talonavicular subluxation was performed, with improvement to a normal range seen in the cases analyzed. The results are encouraging but should be considered preliminary based on the length of follow-up.