Subtalar arthrodesis for late sequelae of calcaneal fractures: Fusion in situ versus fusion with sliding corrective osteotomy

Primary subtalar arthritis is not common. In most cases, it is the late seq uela of intra-articular calcaneal fracture.(7) Subtalar arthrodesis is most ly used for the treatment of traumatic subtalar arthritis in our clinics. W e have compared our early cases of in-situ subtalar fusion with our recent cases of fusion with sliding corrective osteotomy in this clinical report. From 1989 to 1992, 15 feet of 13 patients were treated with subtalar arthro deses for subtalar arthritis caused by malunion of calcaneal fractures. Fus ion in situ was done by Oilier's approach, and resection of bony protrusion was done if there was lateral entrapment syndrome. From 1992 to 1995, 13 f eet of 12 patients also received subtalar arthrodeses to salvage their calc aneal fractures, but the subtalar fusion was done by wide lateral approach, calcaneal sliding corrective osteotomy, and sometimes (11 of 13 feet) with Achilles tendon lengthening to restore the calcaneal height and width. Patients of both groups experienced obvious clinical improvement in subtala r pain relief, but there was no difference with walking distance, running, or jumping. The group undergoing fusion with sliding corrective osteotomy w as more satisfied with regard to cosmetic results and shoe wear. The overal l satisfactory rate in the group who underwent fusion with sliding correcti ve osteotomy (92%) was superior to the group who underwent fusion in situ ( 77%), Though our method of sliding corrective osteotomy does not provide much imp rovement to the talus declination angle, it is suitable for those patients with a "banana"-shaped calcaneus malunion. If the patient has prominent ant erior ankle pain caused by tibiotalar impingement, we believe that a distra ction subtalar arthrodesis would be more appropriate.