Subtalar distraction bone block arthrodesis

This retrospective study analyses the results of subtalar bone block distra ction arthrodesis used in the treatment of late complications of calcaneal fractures, acute severely comminuted fractures, nonunion (and malunion) of attempted subtalar arthrodeses, avascular necrosis of the talus, and club-f oot deformity. Of 39 patients (41 feet) who had this procedure, 35 (37 feet ) returned for follow-up after a mean of 70 months (26 to 140). There were 24 men (25 feet) and 11 women (12 feet) with a mean age of 41 years (16 to 63). Each completed a standardised questionnaire, based on the hindfoot-sco ring system of the American Orthopaedic Foot and Ankle Society and were rev iewed both clinically and radiologically. Of the 37 operations, 32 (87%) ac hieved union. The mean hindfoot score (maximum of 94 points) increased from 21.1 points (8 to 46) preoperatively to 68.9 (14 to 82) at the final follo w-up. The mean talocalcaneal and calcaneal pitch angles were 20.5 degrees a nd 4.9 degrees before operation, 25.9 degrees and 8.3 degrees immediately a fter, and 24.6 degrees and 7.7 degrees at the final follow-up, respectively . The mean talar declination angle improved from 6.5 degrees (-10 to 22) be fore operation to 24.8 degrees (14 to 32) at the final follow-up. The mean talocalcaneal height increased from 68.7 mm before operation to 74.5 mm imm ediately after and 73.5 mm at the final follow-up. Of the 37 arthrodeses av ailable for review, 32 were successful; 29 patients (30 arthrodeses) were s atisfied with the procedure. Minimal loss of hindfoot alignment occurred wh en comparing radiographs taken immediately after operation and at final fol low-up.