lecture 35 shah subtalar fusion
TRANSCRIPT
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Subtalar Arthrodesis
Dr.Rajiv Shah‘Foot & Ankle Orthopaedics’
Foot & Ankle SurgeonPresident, Indian Foot & Ankle
Society
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Aetiology Idiopathic
Post trauma
Post polio
Primary OA
RA, Seroneg.
Neuromuscular
Nerve injury
Tarsal coalition
Flat foot
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DiagnosisLateral foot pain
Inability to walk on uneven ground
Tender sinus tarsi
Decreased ROM
Stiffness
Deformity
Diagnostic injection
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Radiology
Ankle series Foot series Broden views Axial view Saltzmann
view
Reduced joint space
Osteophytes
Post calcaneal malunion arthritisLoss of heel heightLoss of talar declination
Loss of longitudinal medial arch(RA, PTTD)
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Goals of arthrodesis
PainlessStableIn functional positionPlantigrade foot
Position of arthrodesis0-5 degree ankle valgusNeutral TN + CC jointsForefoot - plantigrade
Subtalar fusion
In-situNo deformity
No loss of height
Distraction
Loss of height Post calcaneal or talar body
malunion
Fusion plus osteotomy
Associated with
deformity
Subtalar fusion
No deformityNo height
loss
In-situ
Varus/Valgus
Distraction Medial/later
al graft
Loss of height
Posterior graft
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Before arthrodesis
Motion of surrounding jointsAlignment of foot & ankleStatus of soft tissueNeurovascular status of limbTendoachilles tightnessProximal joints – knee, hip, SI & spine
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Subtalar arthrodesis
Broad, cancelleous, bleeding surfaces in close approximation
Rigid fixation with compression Drilling of subchondral bone &
feathering of surfaces Sos augmentation
Tips & tricks
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Subtalar arthrodesis
Long, well planned incision Good soft tissue mobilization Care of nerves Gentle retraction with K-wires
Tips & tricks
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Subtalar arthrodesis
Always correct deformity, never fuse in situ
Tips & tricks
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Subtalar arthrodesis
Alignment proceeds proximal to distal
Tips & tricks
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Subtalar arthrodesis
Removal of bone to correct deformity shall always precede removal of articular cartilage
Tips & tricks
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Subtalar arthrodesis
FHL marks limit of medial preparation
Tips & tricks
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Subtalar arthrodesis
Distraction with lamina spreaderHinterman’s retractorSkin closure – may be difficult, think before hand
Tips & tricks
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Subtalar arthrodesis
Excised bone is used for deformity correction in distraction subtalar arthrodesis
Tips & tricks
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Subtalar arthrodesis
Sinus TarsiLateral extensile
Approaches
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Subtalar arthrodesis
Posterior approach
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Subtalar arthrodesis + osteotomy
Valgus (less common): transverse, easy to slide
Varus (more common): harder to slide Lateral Translation Dwyer Malerba (step cut)
Inferior Translation: restore loss of height Transverse May need to lengthen Achilles or gastroc
recession
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That’s allThank you…