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Review Question - QID 844

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QID 844 (Type "844" in App Search)
A 55-year-old male sustained a Sanders IV intra-articular calcaneus fracture two years ago that was treated nonoperatively. He presents to your office with a mechanical block preventing his ankle from dorsiflexing to neutral, continued severe pain and a widened heel. Radiographs show significant loss of calcaneal height and an incongruous subtalar joint. What is the most appropriate surgical treatment at this time?

Arthroscopic debridement of the subtalar joint and subfibular recess with in situ subtalar joint arthrodesis

6%

102/1837

Distraction bone block subtalar arthrodesis

75%

1376/1837

Tibiotalocalcaneal arthrodesis

11%

203/1837

Corrective intra-articular osteotomy of the calcaneus

4%

67/1837

Arthroscopic debridement of the subtalar joint and subfibular recess with lateral distraction opening wedge calcaneal osteotomy

4%

78/1837

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The complex pathology in this scenario includes: incongruous subtalar joint, loss of calcaneal body height, and likely decreased lateral talocalcaneal angle. Complications of this injury include pain, shoe wear difficulties, and foot deformity. Foot deformity (collapse of the talus into the posterior facet) can result in tibiotalar neck impingement.

Carr et al described a subtalar fusion technique for late complications of calcaneus fractures that were treated conservatively. The subtalar fusion technique involves distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation. The distraction allows correction of the talocalcaneal relationship and regains lost hindfoot height. (A subtalar fusion would address the pain issue but not the other factors).

Chandler et al states that distraction arthrodesis should be considered only if findings of anterior ankle impingement are present, as is true in this case.

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