Isolated Subtalar Arthrodesis

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WINDSOR UNIVERSITY SCHOOL OF MEDICINE

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Presentation transcript:

Isolated Subtalar Arthrodesis by Paulo N. Ferrao, Nikiforos P. Saragas, and Andrew Strydom JBJS Essent Surg Tech Volume 6(1):e12 March 23, 2016 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Hindfoot valgus malalignment of the left foot as seen from behind the patient. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Weight-bearing oblique (Fig. 2-A), weight-bearing anteroposterior (Fig Weight-bearing oblique (Fig. 2-A), weight-bearing anteroposterior (Fig. 2-B), and weight-bearing lateral (Fig. 2-C) radiographs of a patient with isolated subtalar arthritis. Weight-bearing oblique (Fig. 2-A), weight-bearing anteroposterior (Fig. 2-B), and weight-bearing lateral (Fig. 2-C) radiographs of a patient with isolated subtalar arthritis. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Saltzman view for measuring hindfoot alignment relative to the tibia as described by Donovan and Rosenberg28. Saltzman view for measuring hindfoot alignment relative to the tibia as described by Donovan and Rosenberg28. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The patient is positioned supine with the feet at the edge of the table and a bump under the ipsilateral hip. The patient is positioned supine with the feet at the edge of the table and a bump under the ipsilateral hip. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Two rolled towels are placed under the heel to lift the foot off the table, making surgical access easier. Two rolled towels are placed under the heel to lift the foot off the table, making surgical access easier. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The surgical incision is drawn from below the tip of the lateral malleolus to the base of the 4th metatarsal. The surgical incision is drawn from below the tip of the lateral malleolus to the base of the 4th metatarsal. The superficial peroneal and sural nerves are drawn as dotted lines. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The origin of the extensor digitorum brevis is identified and released. The origin of the extensor digitorum brevis is identified and released. The muscle belly is dissected out distally and sutured to the distal skin. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

A Hohmann retractor is placed deep to the calcaneofibular ligament around the posterior aspect of the subtalar joint, improving exposure and protecting the peroneal tendons. A Hohmann retractor is placed deep to the calcaneofibular ligament around the posterior aspect of the subtalar joint, improving exposure and protecting the peroneal tendons. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

A lamina spreader is used to open the joint, making access for debridement easier. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The flexor hallucis longus tendon is identified in the posteromedial aspect of the subtalar joint. The flexor hallucis longus tendon is identified in the posteromedial aspect of the subtalar joint. It is important not to damage the tendon with osteotomes during debridement. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Autogenous bone graft being taken from the calcaneus. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Autogenous bone graft being taken from the distal part of the tibia. Autogenous bone graft being taken from the distal part of the tibia. The incision is made 2 cm proximal to the tip of the medial malleolus. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Autogenous bone graft from the distal part of the tibia. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The incision marked on the posterior aspect of the heel, off the weight-bearing surface of the foot, for insertion of the screws. The incision marked on the posterior aspect of the heel, off the weight-bearing surface of the foot, for insertion of the screws. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Fully threaded conical headless compression screws. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The guidewires are inserted through the heel into the talus while the joint is reduced. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Posttraumatic subtalar arthritis with loss of calcaneal height and decreased talar declination. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Subtalar bone-block distraction arthrodesis with restored calcaneal height and talar declination. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Lateral fluoroscopic view to confirm that the guidewires were inserted in a divergent pattern and crossing the subtalar joint. Lateral fluoroscopic view to confirm that the guidewires were inserted in a divergent pattern and crossing the subtalar joint. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior fluoroscopic view of the ankle confirming that the guidewires are within the talus. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative fluoroscopy confirming correct screw length and placement. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The extensor digitorum brevis muscle is sutured back to its origin. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

A back slab is applied using 2 plaster splints over a bulky dressing. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

The operatively treated leg immobilized in the below-the-knee plaster slab, with the ankle in a neutral position, and elevated. The operatively treated leg immobilized in the below-the-knee plaster slab, with the ankle in a neutral position, and elevated. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.

Radiograph made at 16 weeks confirming subtalar fusion. Paulo N. Ferrao et al. JBJS Essent Surg Tech 2016;6:e12 ©2016 by The Journal of Bone and Joint Surgery, Inc.