SUBTALAR DISTRACTIONAL REALIGNMENT ARTHRODESIS WITH WEDGE BONE-GRAFTING AND LATERAL DECOMPRESSION FOR CALCANEAL MALUNION

Background: The purpose of this study was to evaluate prospectively th e efficacy of subtalar distractional realignment arthrodesis in the tr eatment of calcaneal malunion associated with subtalar arthritis, coll apse of height, talonavicular subluxation, malalignment of the heel ax is, and widening heel with calcaneo-fibular abutment. Methods: Thirty- four patients with severe calcaneal malunion were treated with a later al approach, lateral decompression, medial subtalar capsulotomy, and d istraction and realignment of the subtalar joint with an anteriorly an d laterally tapered wedge bone graft. The patients were evaluated with a functional rating scale and radiographs, both before and after surg ery. Results: Thirty-two of the 34 patients were evaluated at a mean o f 71 months (range, 60-92 months) after the arthrodesis. Solid subtala r fusion was achieved in 31 of the 32 patients. The average gain of su btalar distraction was 12 mm, Neutral or mild valgus alignment was ach ieved in 26 of the 32 patients. The mean postoperative score (83) show ed significant improvement over the mean preoperative score (47), Over all, the functional rating scale revealed excellent or good results in 26 patients and fair results in 6 patients. Conclusion: Coupled with wedge bone grafting, the subtalar distractional realignment arthrodesi s achieved restoration of hindfoot height and axial alignment with a g ood union rate and significant improvement in the majority of patients with calcaneal malunion.