Eelsing Robin, Al-Sheikh Sally, Halm Jens A, Schepers Tim
Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands.
Foot Ankle Orthop. 2025 Jan 24;10(1):24730114241311895. doi: 10.1177/24730114241311895. eCollection 2025 Jan.
The outcome of a secondary subtalar arthrodesis after prior calcaneal fracture has been widely described. However, the surgical treatment has evolved significantly over the past decade, paralleling the shifts observed in primary repair strategies. Therefore, we describe the outcome following a secondary arthrodesis after an intra-articular calcaneal fracture, comparing the in situ (ISA) and bone block distraction arthrodesis (BBDA) techniques.
In total, 339 patients who underwent a subtalar arthrodesis between January 1998 and November 2022 were screened for eligibility. Inclusion criteria were age ≥16 years, having undergone a subtalar arthrodesis following a calcaneal fracture, and a minimal follow-up of 1 year. Exclusion criteria were subtalar arthrodesis before January 2010 and a subtalar arthrodesis within 6 weeks of injury. A total of 259 patients did not meet the inclusion criteria, resulting in the inclusion of 80 patients with 82 fractured calcanei.
No significant differences between ISA and BBDA in surgical outcome were seen. Subtalar fusion was achieved in 78 of the patients (95.1%). Additionally, a deep surgical site infection occurred in 6 patients (7.8%). The American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS) and Foot Function Index (FFI) scores and the EuroQol-5 dimensions (EQ5D) index were similar between the 2 groups. However, a significantly higher EQ5D-VAS was reported by the subjects who received a BBDA (median [interquartile range], 70.0 [52.0-82.0] vs 81.0 [70.0-90.3], = .021). Multiple regression revealed that a higher Böhler angle before the initial fracture reconstruction significantly improved the AOFAS score, whereas the FFI significantly improved by an initial conservative treatment and implant removal after arthrodesis. Finally, increasing age significantly improved the EQ5D index.
Our study presents comparable surgical outcomes between ISA and BBDA for secondary subtalar arthrodesis following calcaneal fractures. Functional outcomes, as measured by the AOFAS and FFI scores, were also similar between the 2 techniques, although patients undergoing BBDA reported higher EQ5D visual analog scale scores.
Level III, retrospective cohort study.
先前跟骨骨折后继发性距下关节融合术的结果已有广泛描述。然而，在过去十年中，手术治疗方法有了显著发展，这与一期修复策略的转变相平行。因此，我们描述关节内跟骨骨折后继发性关节融合术的结果，比较原位（ISA）和骨块撑开关节融合术（BBDA）技术。
对1998年1月至2022年11月期间接受距下关节融合术的339例患者进行资格筛查。纳入标准为年龄≥16岁、跟骨骨折后接受距下关节融合术且随访时间至少1年。排除标准为2010年1月前的距下关节融合术以及受伤后6周内的距下关节融合术。共有259例患者不符合纳入标准，最终纳入80例患者，共82例骨折跟骨。
ISA和BBDA在手术结果方面无显著差异。78例患者（95.1%）实现了距下关节融合。此外，6例患者（7.8%）发生了深部手术部位感染。两组之间美国矫形足踝协会踝-后足评分（AOFAS）、足功能指数（FFI）评分以及欧洲五维健康量表（EQ5D）指数相似。然而，接受BBDA的患者报告的EQ5D视觉模拟量表评分显著更高（中位数[四分位间距]，70.0[52.0 - 82.0]对81.0[70.0 - 90.3]，P = 0.021）。多元回归分析显示，初次骨折重建前较高的Böhler角显著提高了AOFAS评分，而FFI评分通过初次保守治疗和关节融合术后取出植入物得到显著改善。最后，年龄增加显著提高了EQ5D指数。
我们的研究表明，对于跟骨骨折后继发性距下关节融合术，ISA和BBDA的手术结果具有可比性。两种技术在AOFAS和FFI评分所衡量的功能结果方面也相似，尽管接受BBDA的患者报告的EQ5D视觉模拟量表评分更高。
III级，回顾性队列研究。
