ABSTRACT: To report and evaluate the results of subtalar distraction bone block fusion in the treatment of malunited calcaneus fracture.
From September 2004 to January 2008, 32 cases of malunited calcaneus fracture were treated, among which 28 cases were classified type II and 4 cases type III by Stephens-Sander's classification. Preoperative X-ray and CT examination demonstrated a talocalcaneal angle of 18.1 degrees ± 2.3 degrees , and an AOFAS score of 36.3 ± 4.1. Subtalar distraction bone block fusion was performed in all cases in this series. Regular follow-up was done with talocalcaneal angle measurement and AOFAS scoring.
All the 32 patients had been followed-up of 34 months, ranging from 24 to 65 months, only to reveal a primary wound healing without infection in all but one, in which superficial skin necrosis occurred postoperatively and healed after dressing-changes. Bone healing at the fusion site was seen 3 months after operation in all cases. At the final follow-up, the talocalcaneal angle was 22.9° ± 1.9° and the AOFAS score 77.5 ± 4.1, both demonstrating a significant difference (P < 0.05), when compared with those before operation.
Subtalar distraction bone block fusion, together with the lateral wall decompression, can correct the main deformity and reduce major symptoms induced by the malunion of calcaneus fractures, being a convenient and practical option for the treatment of malunited calcaneus fracture.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2010; 48(9):655-7.
ABSTRACT: To evaluate the effect of treatment of calcaneal malunion fracture with isolated subtalar arthrodesis.
Twenty-one patients with calcaneal malunion fracture, with 21 diseases feet, all males, underwent tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint and were followed up for 16 months (8-47 months). American Orthopedic Foot and Ankle Society and pain score systems were used to evaluate the changes of symptoms. X-ray films were taken to observe the changes of the bones.
The calcaneal deformity was greatly improved in all the patients and the symptom of pain disappeared or was alleviated. The mean post-operational AOFAS score was 71.3 (44-85) points, higher than that before the operation [36.7 (18-56) points]. The pain mean post-operational score was 2.0 (0-4) points, much lower than that before the operation [8.2 (7-10) points].
Surgical treatment including tenolysis of peroneal tendon, lateral exostectomy, and isolated arthrodesis of subtalar joint is effective on calcaneal malunion fracture.
Zhonghua yi xue za zhi 01/2008; 87(47):3343-5.
ABSTRACT: To evaluate the results of intra-articular calcaneal fractures treated with open reduction and internal fixation.
Thirty-five displaced intra-articular calcaneal fractures in 34 patients were treated with open reduction and internal fixation from August 2001 to April 2003. Fracture classification was based on Sanders classification. Extended lateral approach, and fixed the fractures with AO titanium plate for calcaneus were performed. Bone graft was used in selected patients. Thirty-five fractures in thirty-four patients were evaluated using radiographic examinations and ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS). Average follow-up was 18.3 months (range from 12 to 32 months).
There were 30 type II fractures and 5 type III fractures. Average Böhler's angle was 5.6 degrees preoperatively and 28.2 degrees finally. Roentgenographic evaluation of calcaneal body dimensions showed restoration of heel height (97.7%) to virtually normal. Anatomic or near anatomic reductions were obtained in 80% of the cases. The average score was 88.1 for type II fractures, and 78.8 for type III fractures. Excellent or good clinical results occurred in 82.8% type II fractures, and 60.0% type III fractures. The overall excellent or good rate was 79.4%.
From the results, open reduction and internal fixation for Sanders type II and type III fractures are recommended.
Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2005; 43(12):788-91.