Department of Trauma and Reconstructive Surgery, University Hospital "Carl Gustav Garus", Dresden, Germany.
Int Orthop. 2013 Sep;37(9):1707-17. doi: 10.1007/s00264-013-2021-3. Epub 2013 Aug 4.
Hindfoot malunions after fractures of the talus and calcaneus lead to severe disability and pain. Corrective osteotomies and arthrodeses aim at functional rehabilitation and reduction of pain resulting from post-traumatic arthritis, eccentric loading and impingement due to hindfoot malunion. Preoperative analysis should include the three-dimensional outline of the malunion, the presence of post-traumatic arthritis, non-union, or infection, the extent of any avascular necrosis or comorbidities. In properly selected, compliant patients with intact cartilage cover little or no, AVN, and adequate bone quality, a corrective joint-preserving osteotomy with secondary internal fixation may be carried out. In the majority of cases, realignment is augmented by arthrodesis for post-traumatic arthritis. Fusion is restricted to the affected joint(s) to minimise loss of function. Correction of the malunion is achieved by asymmetric joint resection, distraction and structural bone grafting with corrective osteotomies for severe axial malalignment. Bone grafting is also needed after resection of a fibrous non-union, sclerotic or necrotic bone. Numerous clinical studies have shown substantial functional improvement and high subjective satisfaction rates from pain reduction after corrective osteotomies and fusions for post-traumatic hindfoot malalignment. This article reviews the indications, techniques and results of corrective surgery after talar and calcaneal malunions and nonunions based on an easy-to-use classification.
距骨和跟骨骨折后出现的后足畸形愈合会导致严重的残疾和疼痛。矫正性截骨术和关节融合术旨在实现功能康复，并减轻创伤后关节炎、偏心负荷和后足畸形愈合引起的撞击所导致的疼痛。术前分析应包括畸形愈合的三维轮廓、是否存在创伤后关节炎、骨不连或感染、任何骨坏死或并存疾病的程度。在选择合适、依从性好、软骨完整、无或仅有少量 AVN 且骨质量良好的患者中，可进行保留关节的矫正性截骨术和二期内固定术。在大多数情况下，通过关节融合术来矫正创伤后关节炎。融合仅限于受累关节，以尽量减少功能丧失。通过不对称关节切除、牵张和结构性植骨，并进行严重轴向对线不良的矫正性截骨术来纠正畸形愈合。切除纤维性骨不连、硬化或坏死骨后，也需要植骨。大量临床研究表明，对于创伤后后足畸形愈合，通过矫正性截骨术和融合术可显著改善功能，并使疼痛得到极大缓解，患者的主观满意度也很高。本文基于一种易于使用的分类方法，回顾了距骨和跟骨畸形愈合和骨不连的矫正手术的适应证、技术和结果。
