Late Results of Subtalar Distraction Fusion

Abstract

Between 1990 and 1994, 15 subtalar distraction fusions were performed on 14 patients for sequelae of calcaneus fractures. Twelve patients (13 feet) were available for a minimum 2-year follow-up and constituted the composition of this study. All patients complained of lateral ankle pain and had CT evidence of calcaneofibular abutment and radiographic evidence of loss of heel height preoperatively. The average age at time of surgery was 56 years (range, 23–81 years), and the average follow-up was 47 months (range, 25–75 months). The only change in surgical technique from that previously described was the use of a bone spreader rather than a femoral distractor for distraction of the subtalar joint. The average preoperative talocalcaneal angle improved from 27° (range, 19–37°) to 33° (range, 23–45°) postoperatively ( P < 0.003). The mean talar declination angle improved from 11° (range, 6–18°) to 16° (range, 7–27°) postoperatively ( P < 0.003). The mean heel height increased from 71 mm (range, 60–83 mm) to 76 mm (range, 63–91 mm) postoperatively ( P < 0.0001). All patients completed the AOFAS Ankle-Hindfoot scale at latest follow-up, and the average score was 76.1 (range, 57–94). Eleven of 13 outcomes were rated as very satisfactory or satisfactory. Twelve of 13 said they would ‘definitely yes’ do surgery again. We have found that subtalar distraction fusion for late complications of calcaneus fracture in a carefully selected population can provide a consistent and satisfactory outcome.