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İhmal edilmiş ağrılı eklem içi kalkaneus kırıklarında izole subtalar füzyon

Year 2014, Volume: 48 Issue: 5, 541 - 545, 12.11.2014
https://doi.org/10.3944/AOTT.2014.13.0144

Abstract

Amaç: Bu çalışmanın amacı eklem içi kalkaneus kırıklarına ikincil talokalkaneal artroz gelişen hastalarda subtalar artrodez tedavisinin radyolojik ve klinik sonuçlarını değerlendirmekti.

Çalışma planı: 2005-2011 yılları arasında eklem içi kalkaneus kırığı nedeniyle konservatif tedavi uygulanan ve semptomatik subtalar artroz nedeniyle subtalar artrodez yapılan 20 hasta (21 ayak) çalışmaya alındı. On bir hastada otogreft veya allogreft kullanıldı. Hastaların klinik sonuçları American Orthopaedic Foot and Ankle Society (AOFAS) ayak bileği art-ayak skoru ile değerlendirildi. Art-ayak dizilimi, subtalar füzyonun kalitesi ve diğer eklemlerde oluşan artroz radyolojik olarak değerlendirildi.

Bulgular: Ortalama takip süresi 43 (dağılım: 21-83) aydı. Cerrahi öncesi AOFAS skoru ortalama 61.7 (dağılım: 40-67) ve sonrası AOFAS skoru ortalama 84.2 (dağılım: 65-94) bulundu ve aradaki fark istatistiksel olarak anlamlıydı (p=0.001). Altı hastada mükemmel, 8 hastada iyi ve 6 hastada orta sonuç elde edildi. On dokuz hastada (20 ayak) tam füzyon sağlandı. İki hastada midtarsal eklemlerde radyolojik olarak artritik değişiklikler gözlenmekle birlikte bu değişiklikler semptomatik değildi. Cerrahi öncesi ve sonrası radyolojik ölçümler arasında istatistiksel olarak anlamlı fark saptanmadı. Yanlış kaynama gözlenen hasta olmadı.

Çıkarımlar: Subtalar artrodez radyolojik ve klinik olarak belirgin fayda sağlamakla birlikte midtarsal eklemlerde orta derecede ve asemptomatik osteoartrite neden olabilmektedir.

References

  • Easley ME, Trnka HJ, Schon LC, Myerson MS. Isolated sub- talar arthrodesis. J Bone Joint Surg Am 2000;82:613-24.
  • Davies MB, Rosenfeld PF, Stavrou P, Saxby TS. A com- prehensive review of subtalar arthrodesis. Foot Ankle Int 2007;28:295-7. CrossRef
  • Myerson M, Quill GE Jr. Late complications of fractures of the calcaneus. J Bone Joint Surg Am 1993;75:331-41.
  • Johansson JE, Harrison J, Greenwood FA. Subtalar arthrod- esis for adult traumatic arthritis. Foot Ankle 1982;2:294-8.
  • Mizel MS, Temple HT, Michelson JD, Alvarez RG, Clan- ton TO, Frey CC, et al. Thromboembolism after foot and ankle surgery. A multicenter study. Clin Orthop Relat Res 1998;348:180-5. CrossRef
  • Mann RA, Baumgarten M. Subtalar fusion for isolated sub- talar disorders. Preliminary report. Clin Orthop Relat Res 1988;226:260-5.
  • Russotti GM, Cass JR, Johnson KA. Isolated talocalcaneal arthrodesis. A technique using moldable bone graft. J Bone Joint Surg Am 1988;70:1472-8.
  • Astion DJ, Deland JT, Otis JC, Kenneally S. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am 1997;79:241-6.
  • Wülker N, Stukenborg C, Savory KM, Alfke D. Hind- foot motion after isolated and combined arthrodeses: measurements in anatomic specimens. Foot Ankle Int 2000;21:921-7.
  • Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myer- son MS, Sanders M. Clinical rating systems for the ankle- hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53. CrossRef
  • Zwipp H, Rammelt S, Barthel S. Calcaneal fractures--open reduction and internal fixation (ORIF). Injury 2004;35 Suppl 2:SB46-54. CrossRef
  • Huang PJ, Chen SK, Chen YW, Cheng YM, Lin SY, Hsu CY. Subtalar arthrodesis for subtalar arthritis. Kaohsiung J Med Sci 1997;13:677-81.
  • Kitaoka HB, Patzer GL. Subtalar arthrodesis for poste- rior tibial tendon dysfunction and pes planus. Clin Orthop Relat Res 1997;345:187-94. CrossRef
  • Joveniaux P, Harisboure A, Ohl X, Dehoux E. Long- term results of in situ subtalar arthrodesis. Int Orthop 2010;34:1199-205. CrossRef
  • Amendola A, Lammens P. Subtalar arthrodesis using inter- position iliac crest bone graft after calcaneal fracture. Foot Ankle Int 1996;17:608-14. CrossRef
  • Rammelt S, Grass R, Zawadski T, Biewener A, Zwipp H. Foot function after subtalar distraction bone-block arthrodesis. A prospective study. J Bone Joint Surg Br 2004;86:659-68. CrossRef
  • Chandler JT, Bonar SK, Anderson RB, Davis WH. Re- sults of in situ subtalar arthrodesis for late sequelae of cal- caneus fractures. Foot Ankle Int 1999;20:18-24.
  • 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;27:229-35.
  • Scranton PE Jr. Results of arthrodesis of the tarsus: ta- localcaneal, midtarsal, and subtalar joints. Foot Ankle 1991;12:156-64. CrossRef
  • Dahm DL, Kitaoka HB. Subtalar arthrodesis with internal compression for post-traumatic arthritis. J Bone Joint Surg Br 1998;80:134-8. CrossRef
  • Huang PJ, Fu YC, Cheng YM, Lin SY. Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy. Foot Ankle Int 1999;20:166-70. CrossRef
  • Carr JB, Hansen ST, Benirschke SK. Subtalar distraction bone block fusion for late complications of os calcis frac- tures. Foot Ankle 1988;9:81-6. CrossRef
  • Jardé O, Trinquier JL, Renaux P, Mauger S, Vives P. Subta- lar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases. [Article in French] Rev Chir Orthop Repara- trice Appar Mot 1994;80:728-33. [Abstract]
  • Trnka HJ, Easley ME, Lam PW, Anderson CD, Schon LC, Myerson MS. Subtalar distraction bone block arthrodesis. J Bone Joint Surg Br 2001;83:849-54. CrossRef
  • de Heus JA, Marti RK, Besselaar PP, Albers GH. The in- fluence of subtalar and triple arthrodesis on the tibiotalar joint. A long-term follow-up study. J Bone Joint Surg Br 1997;79:644-7. CrossRef

Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures

Year 2014, Volume: 48 Issue: 5, 541 - 545, 12.11.2014
https://doi.org/10.3944/AOTT.2014.13.0144

Abstract

Objective: The objective of this study was to evaluate the radiological and clinical outcomes of treatment of subtalar arthrodesis in patients developing talocalcaneal arthrosis secondary to intra-articular calcaneal fractures.

Methods: The study included 20 patients (21 feet) who underwent subtalar arthrodesis due to symptomatic subtalar arthrosis following conservative treatment for intra-articular calcaneal fracture between 2005 and 2011. Autograft or allograft was used in 11 patients. Patients were evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Hindfoot alignment, quality of subtalar fusion and arthritis occurring in other joints were used for the radiological evaluations.

Results: Mean duration of follow-up was 43 (range: 21 to 83) months. Mean preoperative AOFAS score was 61.7 (range: 40 to 67) and mean postoperative AOFAS score was 84.2 (range: 65 to 94). The difference between scores was statistically significant (p=0.001). Six patients had excellent, 8 good and 6 fair results. Complete fusion was achieved in 19 patients (20 feet). In 2 patients, arthritic changes were radiologically observed in the midtarsal joints. These changes were not symptomatic. There were no statistically significant differences between pre- and postoperative radiological measurements. No patients experienced malunion.

Conclusion: While subtalar arthrodesis appears to provide radiological and clinical benefits, it may cause moderate and asymptomatic osteoarthritis in the midtarsal joints.

References

  • Easley ME, Trnka HJ, Schon LC, Myerson MS. Isolated sub- talar arthrodesis. J Bone Joint Surg Am 2000;82:613-24.
  • Davies MB, Rosenfeld PF, Stavrou P, Saxby TS. A com- prehensive review of subtalar arthrodesis. Foot Ankle Int 2007;28:295-7. CrossRef
  • Myerson M, Quill GE Jr. Late complications of fractures of the calcaneus. J Bone Joint Surg Am 1993;75:331-41.
  • Johansson JE, Harrison J, Greenwood FA. Subtalar arthrod- esis for adult traumatic arthritis. Foot Ankle 1982;2:294-8.
  • Mizel MS, Temple HT, Michelson JD, Alvarez RG, Clan- ton TO, Frey CC, et al. Thromboembolism after foot and ankle surgery. A multicenter study. Clin Orthop Relat Res 1998;348:180-5. CrossRef
  • Mann RA, Baumgarten M. Subtalar fusion for isolated sub- talar disorders. Preliminary report. Clin Orthop Relat Res 1988;226:260-5.
  • Russotti GM, Cass JR, Johnson KA. Isolated talocalcaneal arthrodesis. A technique using moldable bone graft. J Bone Joint Surg Am 1988;70:1472-8.
  • Astion DJ, Deland JT, Otis JC, Kenneally S. Motion of the hindfoot after simulated arthrodesis. J Bone Joint Surg Am 1997;79:241-6.
  • Wülker N, Stukenborg C, Savory KM, Alfke D. Hind- foot motion after isolated and combined arthrodeses: measurements in anatomic specimens. Foot Ankle Int 2000;21:921-7.
  • Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myer- son MS, Sanders M. Clinical rating systems for the ankle- hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53. CrossRef
  • Zwipp H, Rammelt S, Barthel S. Calcaneal fractures--open reduction and internal fixation (ORIF). Injury 2004;35 Suppl 2:SB46-54. CrossRef
  • Huang PJ, Chen SK, Chen YW, Cheng YM, Lin SY, Hsu CY. Subtalar arthrodesis for subtalar arthritis. Kaohsiung J Med Sci 1997;13:677-81.
  • Kitaoka HB, Patzer GL. Subtalar arthrodesis for poste- rior tibial tendon dysfunction and pes planus. Clin Orthop Relat Res 1997;345:187-94. CrossRef
  • Joveniaux P, Harisboure A, Ohl X, Dehoux E. Long- term results of in situ subtalar arthrodesis. Int Orthop 2010;34:1199-205. CrossRef
  • Amendola A, Lammens P. Subtalar arthrodesis using inter- position iliac crest bone graft after calcaneal fracture. Foot Ankle Int 1996;17:608-14. CrossRef
  • Rammelt S, Grass R, Zawadski T, Biewener A, Zwipp H. Foot function after subtalar distraction bone-block arthrodesis. A prospective study. J Bone Joint Surg Br 2004;86:659-68. CrossRef
  • Chandler JT, Bonar SK, Anderson RB, Davis WH. Re- sults of in situ subtalar arthrodesis for late sequelae of cal- caneus fractures. Foot Ankle Int 1999;20:18-24.
  • 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;27:229-35.
  • Scranton PE Jr. Results of arthrodesis of the tarsus: ta- localcaneal, midtarsal, and subtalar joints. Foot Ankle 1991;12:156-64. CrossRef
  • Dahm DL, Kitaoka HB. Subtalar arthrodesis with internal compression for post-traumatic arthritis. J Bone Joint Surg Br 1998;80:134-8. CrossRef
  • Huang PJ, Fu YC, Cheng YM, Lin SY. Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy. Foot Ankle Int 1999;20:166-70. CrossRef
  • Carr JB, Hansen ST, Benirschke SK. Subtalar distraction bone block fusion for late complications of os calcis frac- tures. Foot Ankle 1988;9:81-6. CrossRef
  • Jardé O, Trinquier JL, Renaux P, Mauger S, Vives P. Subta- lar arthrodesis for sequelae of calcaneal fractures. Apropos of 57 cases. [Article in French] Rev Chir Orthop Repara- trice Appar Mot 1994;80:728-33. [Abstract]
  • Trnka HJ, Easley ME, Lam PW, Anderson CD, Schon LC, Myerson MS. Subtalar distraction bone block arthrodesis. J Bone Joint Surg Br 2001;83:849-54. CrossRef
  • de Heus JA, Marti RK, Besselaar PP, Albers GH. The in- fluence of subtalar and triple arthrodesis on the tibiotalar joint. A long-term follow-up study. J Bone Joint Surg Br 1997;79:644-7. CrossRef
There are 25 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Umut Yavuz This is me

Sami Sokucu This is me

Bilal Demir This is me

Devrim Ozer This is me

Cagri Ozcan This is me

Yavuz S. Kabukcuoglu This is me

Publication Date November 12, 2014
Published in Issue Year 2014 Volume: 48 Issue: 5

Cite

APA Yavuz, U., Sokucu, S., Demir, B., Ozer, D., et al. (2014). Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthopaedica Et Traumatologica Turcica, 48(5), 541-545. https://doi.org/10.3944/AOTT.2014.13.0144
AMA Yavuz U, Sokucu S, Demir B, Ozer D, Ozcan C, Kabukcuoglu YS. Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthopaedica et Traumatologica Turcica. November 2014;48(5):541-545. doi:10.3944/AOTT.2014.13.0144
Chicago Yavuz, Umut, Sami Sokucu, Bilal Demir, Devrim Ozer, Cagri Ozcan, and Yavuz S. Kabukcuoglu. “Isolated Subtalar Fusion for Neglected Painful Intra-Articular Calcaneal Fractures”. Acta Orthopaedica Et Traumatologica Turcica 48, no. 5 (November 2014): 541-45. https://doi.org/10.3944/AOTT.2014.13.0144.
EndNote Yavuz U, Sokucu S, Demir B, Ozer D, Ozcan C, Kabukcuoglu YS (November 1, 2014) Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthopaedica et Traumatologica Turcica 48 5 541–545.
IEEE U. Yavuz, S. Sokucu, B. Demir, D. Ozer, C. Ozcan, and Y. S. Kabukcuoglu, “Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures”, Acta Orthopaedica et Traumatologica Turcica, vol. 48, no. 5, pp. 541–545, 2014, doi: 10.3944/AOTT.2014.13.0144.
ISNAD Yavuz, Umut et al. “Isolated Subtalar Fusion for Neglected Painful Intra-Articular Calcaneal Fractures”. Acta Orthopaedica et Traumatologica Turcica 48/5 (November 2014), 541-545. https://doi.org/10.3944/AOTT.2014.13.0144.
JAMA Yavuz U, Sokucu S, Demir B, Ozer D, Ozcan C, Kabukcuoglu YS. Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthopaedica et Traumatologica Turcica. 2014;48:541–545.
MLA Yavuz, Umut et al. “Isolated Subtalar Fusion for Neglected Painful Intra-Articular Calcaneal Fractures”. Acta Orthopaedica Et Traumatologica Turcica, vol. 48, no. 5, 2014, pp. 541-5, doi:10.3944/AOTT.2014.13.0144.
Vancouver Yavuz U, Sokucu S, Demir B, Ozer D, Ozcan C, Kabukcuoglu YS. Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures. Acta Orthopaedica et Traumatologica Turcica. 2014;48(5):541-5.