Skip Navigation
Skip to contents

J Musculoskelet Trauma : Journal of Musculoskeletal Trauma

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > J Musculoskelet Trauma > Volume 32(3); 2019 > Article
Original Article Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture
Hong Gi Park, Jae Ang Sim, Han Soul Kim, Byung Hoon Lee
Journal of Musculoskeletal Trauma 2019;32(3):121-127.
DOI: https://doi.org/10.12671/jkfs.2019.32.3.121
Published online: July 31, 2019
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea. oselite@gilhospital.com

next
  • 42 Views
  • 0 Download
  • 0 Crossref
  • 0 Scopus
next
Full Article

Download PDF Download PDF

Abstract

PURPOSE
The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography.
MATERIALS AND METHODS
The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017.
RESULTS
An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%).
CONCLUSION
Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.


J Korean Fract Soc. 2019 Jul;32(3):121-127. Korean.
Published online Jul 24, 2019.
https://doi.org/10.12671/jkfs.2019.32.3.121
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Original Article

Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

Hong-Gi Park, M.D., Jae Ang Sim, M.D., Ph.D., Han Soul Kim, M.D. and Byung Hoon Lee, M.D., Ph.D.
    • Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
  • Correspondence to: Byung Hoon Lee, M.D., Ph.D. Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, 21 Namdongdaero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-3384, Fax: +82-32-423-3384, Email: oselite@gilhospital.com
Received May 09, 2019; Revised May 31, 2019; Accepted May 31, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography.

Materials and Methods

The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intra-articular calcaneal fracture from December 2012 to April 2017.

Results

An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%).

Conclusion

Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intra-articular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.

Keywords
Calcaneus, Fractures, Intra-articular, Subtalar joint, Arthritis, Computed tomography, Arthrodesis

Figures

Fig. 1
Case of a 52-year-old male's radiologic image series undergoing subtalar arthrodesis. (A) The initial simple foot lateral X-ray shows an intraarticular calcaneal fracture. (B) The initial coronal view of the subtalar joint posterior facet in computed tomography (CT) image shows an intraarticular calcaneal fracture. The black line indicates the uninjured region and the white line indicates the injured region. (C) Simple lateral foot X-ray was performed after surgery. (D) The CT coronal view shows arthritic changes in the subtalar joint. (E) Simple lateral foot X-ray was performed after subtalar arthrodesis. The CT sagittal view shows partial union of the subtalar joint after subtalar arthrodesis (F), CT coronal view shows partial union of the subtalar joint after subtalar arthrodesis (G).

Fig. 2
The fusion ratio was calculated by dividing the total sum of fused segment length, shown as the short dashed arrow, by the total sum of posterior subtalar joint length, shown as the long solid arrow.

Tables

Table 1
Computed Tomography Ankle OA Grading Scale

Table 2
Summary of the Demographic Data, Radiologic and Clinical Results

Notes

Financial support:None.

Conflict of interests:None.

References

    1. Easley ME, Trnka HJ, Schon LC, Myerson MS. Isolated subtalar arthrodesis. J Bone Joint Surg Am 2000;82:613–624.
    1. Ferrao PN, Saragas NP, Strydom A. Isolated subtalar arthrodesis. JBJS Essent Surg Tech 2016;6:e12
    1. Tuijthof GJ, Beimers L, Kerkhoffs GM, Dankelman J, Dijk CN. Overview of subtalar arthrodesis techniques: options, pitfalls and solutions. Foot Ankle Surg 2010;16:107–116.
    1. Bèzes H, Massart P, Delvaux D, Fourquet JP, Tazi F. The operative treatment of intraarticular calcaneal fractures. Indications, technique, and results in 257 cases. Clin Orthop Relat Res 1993;290:55–59.
    1. Myerson MS. Primary subtalar arthrodesis for the treatment of comminuted fractures of the calcaneus. Orthop Clin North Am 1995;26:215–227.
    1. Vulcano E, Ellington JK, Myerson MS. The spectrum of indications for subtalar joint arthrodesis. Foot Ankle Clin 2015;20:293–310.
    1. Jones CP, Coughlin MJ, Shurnas PS. Prospective CT scan evaluation of hindfoot nonunions treated with revision surgery and low-intensity ultrasound stimulation. Foot Ankle Int 2006;27:229–235.
    1. Coughlin MJ, Grimes JS, Traughber PD, Jones CP. Comparison of radiographs and CT scans in the prospective evaluation of the fusion of hindfoot arthrodesis. Foot Ankle Int 2006;27:780–787.
    1. Sanders R, Vaupel ZM, Erdogan M, Downes K. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10–20 years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 2014;28:551–563.
    1. Cohen MM, Vela ND, Levine JE, Barnoy EA. Validating a new computed tomography atlas for grading ankle osteoarthritis. J Foot Ankle Surg 2015;54:207–213.
    1. Dorsey ML, Liu PT, Roberts CC, Kile TA. Correlation of arthrodesis stability with degree of joint fusion on MDCT. AJR Am J Roentgenol 2009;192:496–499.
    1. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349–353.
    1. DiDomenico LA, Butto DN. Subtalar joint arthrodesis for elective and posttraumatic foot and ankle deformities. Clin Podiatr Med Surg 2017;34:327–338.
    1. Davies MB, Rosenfeld PF, Stavrou P, Saxby TS. A comprehensive review of subtalar arthrodesis. Foot Ankle Int 2007;28:295–297.
    1. Chahal J, Stephen DJ, Bulmer B, Daniels T, Kreder HJ. Factors associated with outcome after subtalar arthrodesis. J Orthop Trauma 2006;20:555–561.
    1. Kitaoka HB, Patzer GL. Subtalar arthrodesis for posterior tibial tendon dysfunction and pes planus. Clin Orthop Relat Res 1997;(345):187–194.
    1. Vilá y Rico J, Jiménez Díaz V, Bravo Giménez B, Mellado Romero MÁ, Ojeda Thies C. Results of arthroscopic subtalar arthrodesis for adult-acquired flatfoot deformity vs posttraumatic arthritis. Foot Ankle Int 2016;37:198–204.
    1. Scranton PE Jr. Results of arthrodesis of the tarsus: talocalcaneal, midtarsal, and subtalar joints. Foot Ankle 1991;12:156–164.
    1. Ishikawa SN, Murphy GA, Richardson EG. The effect of cigarette smoking on hindfoot fusions. Foot Ankle Int 2002;23:996–998.
  • PubReader PubReader
  • Cite
    CITE
    export Copy Download
    Close
    Download Citation
    Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
    Format:
    • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
    • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
    Include:
    • Citation for the content below
    Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture
    J Korean Fract Soc. 2019;32(3):121-127.   Published online July 31, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.3.121
    Close
J Musculoskelet Trauma : Journal of Musculoskeletal Trauma
© The Korean Fracture Society.
Close layer
TOP