The Treatment of Calcaneal Malunion

Aims We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602.

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Is There a Borderline Value in the Radiological Findings of Patients With Calcaneal Malunion That May Help to Select an Appropriate Treatment Option?

Foot & Ankle International ◽

10.1177/10711007211027298 ◽

2021 ◽

pp. 107110072110272

Author(s):

Nikita Konovalchuk ◽

Evgenii Sorokin ◽

Viktor Fomichev ◽

Dmitrii Chugaev ◽

Alexander Kochish ◽

...

Keyword(s):

Clinical Outcomes ◽

Operative Treatment ◽

X Rays ◽

Subtalar Arthrodesis ◽

Number Of Patients ◽

Reconstructive Operations ◽

Declination Angle ◽

Calcaneal Malunion ◽

Radiological Measurements

Background: Despite the constant evolution of technological support, operative techniques, and rehabilitation techniques after conservative treatment and operative treatment, a considerable number of patients with calcaneal fractures have constant pain, frequently resulting in loss of occupation. There are numerous options for the operative treatment of painful calcaneal malunion; however, very few publications suggest specific radiological measurements for pre- and postoperative planning—even fewer have statistically analyzed how these radiological measurements affect clinical outcomes. Methods: We performed a retrospective study of 100 patients after operative treatment of calcaneal malunion to determine the correlation between radiological measurements and clinical outcomes. Data were used to create an algorithm that would help to choose between in situ subtalar arthrodesis and complex reconstructive operations. The algorithm was then used to treat 27 prospective patients. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog scale (VAS) were used for clinical assessment, whereas standard weightbearing anteroposterior (AP), lateral (LAT) ankle x-rays, and long axial hindfoot view were used for radiological assessment. Results: The talar declination angle was positively correlated with clinical outcome. Patients with talar declination angles less than 6.5 degrees showed worse results in AOFAS score than patients with a greater angle did (57.3 ± 15.3 and 81 ± 15.6, respectively). Conclusion: The combination of subtalar arthrodesis with distraction bone block or calcaneal osteotomy in patients with calcaneal malunion and a talar declination angle less than 6.5 degrees showed better results than isolated in situ arthrodesis. Level of Evidence Level III, retrospective cohort study, case series.

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Treatment for calcaneal malunion

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-1110-0 ◽

2012 ◽

Vol 23 (8) ◽

pp. 961-966 ◽

Cited By ~ 7

Author(s):

Mohamed Ebrahim Ali Al-Ashhab

Keyword(s):

Calcaneal Malunion

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Calcaneal Malunions: Results of a Prognostic Computed Tomography Classification System

Foot & Ankle International ◽

10.1177/107110079601700707 ◽

1996 ◽

Vol 17 (7) ◽

pp. 395-401 ◽

Cited By ~ 100

Author(s):

Heidi Multhopp Stephens ◽

Roy Sanders

Keyword(s):

Computed Tomography ◽

Classification System ◽

Prognostic Significance ◽

Lateral Wall ◽

Nonoperative Treatment ◽

Type I ◽

Posttraumatic Arthritis ◽

Significant Clinical Improvement ◽

Calcaneal Malunion ◽

A Prospective Study

Following nonoperative treatment of calcaneal fractures, some patients may develop a disabling malunion with associated posttraumatic arthritis of the subtalar joint, impingement of the peroneal tendons, and hindfoot malalignment. We present a computed tomography classification system for calcaneal malunions which guides treatment and is of prognostic significance. A prospective study was performed using this classification system on a series of 26 malunions treated over a 45-month period. Three distinct types of malunions were identified: type I, lateral wall exostosis without subtalar arthrosis; type II, lateral wall exostosis with subtalar arthrosis; and type III, lateral wall exostosis, subtalar arthrosis, and a varus malunion. The surgical treatment was determined by a protocol based on the specific type of malunion encountered. Results were evaluated using the Maryland Foot Score. There were 18 excellent, 5 good, and 3 fair results. Although outcomes deteriorated as malunion complexity increased, significant clinical improvement as a result of reconstructive surgery was noted in even the worst types of malunion. This algorithm is consistent, prognostic, and useful for the orthopaedic surgeon presented with a symptomatic calcaneal malunion of one of these types.

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One approach for treatment of calcaneal malunion

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.375 ◽

2017 ◽

Vol 23 ◽

pp. 95

Author(s):

A. El-hawary ◽

A. Elgeidi ◽

M. Ahmed ◽

H. El-Mowafi

Keyword(s):

Calcaneal Malunion

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Mid-term follow up results of Calcaneal Reconstruction for the Late Complication of Calcaneus Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00315 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0031

Author(s):

Young Koo Lee ◽

Joong hyeon Ahn

Keyword(s):

Corrective Osteotomy ◽

Clinical Results ◽

Calcaneal Fracture ◽

Complication Rates ◽

Vas Score ◽

Subtalar Arthrodesis ◽

Subtalar Arthritis ◽

Calcaneal Malunion ◽

The Mean

Category: Trauma Introduction/Purpose: Calcaneal fracture is the most common fracture in hindfoot. The treatment is challenging, because of various patterns of fractures and high complication rates which leads to high level of dysfunction and low satisfaction of the patients. There are many previous studies reporting various methods about treatment of calcaneal malunion, such as subtalar arthrodesis, corrective osteotomy and corrective osteotomy with subtalar arthrodesis. However, there are no mid-term clinical results reporting about lateral ostectomy and sliding osteotomy, which is called calcaneal reconstruction. The purpose of this study is to evaluate the mid-term clinical and radiologic results of calcaneal reconstruction in the patients who have chronic complications after calcaneal fracture. Methods: Between January 2009 to May 2014, 196 patients (257 feet) were treated by calcaneal fracture. 34 patients (37 feet) underwent calcaneal reconstruction because of the dysfunction and the pain caused by malunion. Inclusion criteria were those whom underwent calcaneal reconstruction and able to be followed up at least 4 years postoperatively. The patients who had severe subtalar arthritis or whom underwent subtalar arthrodesis or simple bone resection were excluded. We reviewed 10 patients (10 feet) postoperatively and at mid-term follow up. Radiologic results including Böhler angle, calcaneal pitch, talocalcaneal height, talar inclination, talocalcaneal angle, talo-1st metatarsal angle, calcaneal width were measured and clinical results including AOFAS Ankle-Hindfoot scale and VAS score were checked preoperative, postoperatively and at the last follow up. The satisfaction of the patient was checked by survey. Results: The mean interval between the first operation and reconstructive operation was 16.6 months. The mean follow-up period after calcaneal reconstruction was 67.1 months. The most common symptom of the patient were pain on the inferior aspect of the lateral malleolus (4 patients) and heel area (3 patients). After calcaneal reconstruction, all the mean values of talocalcaneal height, calcaneal pitch, and Böhler angle were improved, which was statistically significant, respectively. In the postoperative period, 3 patients were very satisfied, 5 were satisfied, and 2 were not satisfied. The results maintained till mid-term follow up. Also, AOFAS and VAS score were improved comparing pre-reconstruction and mid-term follow up. Although the pain did not completely resolved, most of the patients were satisfied postoperatively. Conclusion: In patients without severe subtalar arthritis, the known main causes of the pain in calcaneal malunion are the loss of calcaneal height and hindfoot widening rather than subtalar arthritis. Our results showed signigficant clinical and radiological results by calcaneal reconstruction. And the outcome maintained till mid-term follow up. Calcaneal reconstruction can be a good choice for chronic pain which is caused by malunion of calcaneal fracture without severe subtalar arthritis.

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