2017 ISAKOS Biennial Congress ePoster #104
The Current Operative Techniques of Subtalar Arthrodesis
Kanglai Tang, MD, PhD, Prof., Chongqing, Chongqing CHINA
Department of Orthopedic Surgery, Southwest Hospital, Third Military Medical University / COA National Training Center for Foot and Ankle Surgeon, Chongqing, Chongqing, CHINA
FDA Status Cleared
Summary
The Current Operative Techniques of Subtalar Arthrodesis
ePosters will be available shortly before Congress
Abstract
Subtalar arthrodesis is the preferred treatment for serious subtalar disease. The general technique was divided into phases: surgical approach, cartilage removal, bone graft selection, hindfoot deformity correction and fixation. We modified traditional surgical approach and fixation techniques.
The surgical approach included lateral approach, where either an oblique incision is made over the sinus tarsi, an incision from the tip of the fibula to the base of the 4th metatarsal, or a longitudinal L-shape incision, a posterior approach using an incision on the lateral side parallel to the Achilles tendon, various combinations of access portals in arthroscopic techniques. The mini-open incision of about 3.0 cm over the sinus tarsi is our favor.
The creation of bleeding contact surfaces of the subtalar joint is a key step in obtaining solid fusion. All cartilage should be removed with a chisel and an osteotome. Bone grafts can be applied in case of bone defects or in patients where correction of alignment is needed, which included: cortical, cancellous, combined corticocancellous grafts, and cancellous bone grafts. Cortical grafts provide a strong and stiff strut which is suitable for correction of hindfoot deformity. Corticocancellous bone grafts are advocated by us.
The fixation techniques included external fixation, Kirschner wires and screws. Three approaches for screws are described for fixation: the anterior approach with the screw inserted from the talar neck in the calcaneus, the posterior approach with the screw inserted from the calcaneal tuberosity in the talus and the plantar approach. However, because of the small area of the talar neck, placement of supplemental fixation from anterior to posterior would be difficult. The double opposite orientation is a good choice to fix the subtalar joint. Because the medial talus is thinner than the lateral talus, the first screw should be from talus to calcaneus in the lateral side, and the second screw should be opposite to the first screw in the medial side.
Key words: Subtalar arthrodesis, Surgical approach, Fixation