Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester University Foundation Trust, United Kingdom.
Foot (Edinb). 2020 Mar;42:101647. doi: 10.1016/j.foot.2019.10.002. Epub 2019 Oct 24.
Displaced intraarticular calcaneum fractures are associated with late symptomatic hind foot malalignment and painful arthrosis for which distraction subtalar fusion might be considered. During subtalar distraction arthrodesis, a structural graft is often used to fill gaps. Autograft, the current gold standard, is limited in availabilityand is associated with donor-site morbidity and collapse. Allografts have the risk of infectious disease transmission, rejection and failure to integrate. The clinical outcomes and midterm results of subtalar distraction arthrodesis with biofoamtitanium wedges are presented.
A review of 4 patients (3 male and 1 female) undergoing subtalar bone block distraction arthrodesis using biofoam titanium wedges is reported. Results were evaluated clinically and radiologically Mean time from trauma to surgery was 27.5 months and mean follow up was 12 months.
The mean FAAM ADL score improved from 31.4% preoperatively to 74.2% postoperatively and mean AOFAS score improved from 23.4 preoperatively to 69.6 postoperatively.There was improvement in all radiographic parameters, with 44% improvement in calcaneal pitch, 23% improvement in talocalcaneal angle, 21% increase in talus-first metatarsal angle, and 13.5% correction of talocalcaneal height. VAS Pain scores wasimproved from a pre-operative mean of 8 to a post-operative mean of 2. Mean time to fusion was 13 weeks. Union was achieved in all cases.
Our data suggest titanium wedges may be used as a structural graft option for subtalar bone block distraction arthrodesis. Fusion rates and time to incorporation are comparable to autogenous bone graft without the associated morbidity. Level IV Case Series.
关节内跟骨骨折移位与后足对线不良和疼痛性关节炎有关，可考虑行距下关节撑开融合术。在距下关节撑开融合术中，常使用结构性移植物来填充间隙。自体移植物是目前的金标准，但存在供区并发症和移植物吸收的风险。同种异体移植物存在传染病传播、排斥和无法整合的风险。本文介绍了生物泡沫钛楔形骨块距下骨块撑开融合术的临床疗效和中期结果。
回顾性分析了 4 例（3 例男性，1 例女性）接受生物泡沫钛楔形骨块距下骨块撑开融合术的患者。对患者进行临床和影像学评估。平均受伤至手术时间为 27.5 个月，平均随访时间为 12 个月。
FAAM-ADL 评分从术前的 31.4%提高到术后的 74.2%，AOFAS 评分从术前的 23.4 提高到术后的 69.6。所有影像学参数均得到改善，跟骨角增加 44%，距下关节角增加 23%，距骨-第一跖骨角增加 21%，距下关节高度增加 13.5%。VAS 疼痛评分从术前的平均 8 分降至术后的平均 2 分。平均融合时间为 13 周。所有病例均获得愈合。
我们的数据表明，钛楔形骨块可用作距下骨块撑开融合术的结构性移植物选择。融合率和融合时间与自体骨移植相当，而无相关并发症。病例系列 IV 级。
