Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

Hong-Gi Park; Jae Ang Sim; Han Soul Kim; Byung Hoon Lee

doi:10.12671/jkfs.2019.32.3.121

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Park, Sim, Kim, and Lee: Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

Original Article

J Korean Fract Soc 2019;32(3):121-127.

Published online: 10 January 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.3.121

Computed Tomography Image Analysis of the Fusion Site of Subtalar Arthrodesis for Traumatic Arthritis after a Displaced Intraarticular Calcaneal Fracture

Hong-Gi Park, M.D., Jae Ang Sim, M.D., Han Soul Kim, M.D., Byung Hoon Lee, M.D., Ph.D.

Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea

Correspondence to: Byung Hoon Lee, M.D., Ph.D. Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-3384 Fax: +82-32-423-3384 E-mail: oselite@gilhospital.com

Received 9 May 2019 Revised 31 May 2019 Accepted 31 May 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The study examined the fusion site and characteristics of the subtalar arthrodesis after intraarticular calcaneal fractures using computed tomography.

Materials and Methods

The clinical results and computed tomographic analysis of the fusion site were reviewed in 18 patients who were followed-up for a minimum of six months after undergoing subtalar arthrodesis due to traumatic arthritis caused by an intraarticular calcaneal fracture from December 2012 to April 2017.

Results

An evaluation of clinical results after subtalar arthrodesis revealed statistically significant improvements. In all cases, arthritis was found in the injured articular surface, which was displaced superolaterally from the initial primary fracture line of the calcaneus. Six months after arthrodesis, the subtalar fusion rate was 80.0% (16/20). Of these, 14 cases had a cannulated screw inserted in the uninjured site that is medial to the primary fracture line. Joint fusion was observed on the uninjured articular surface in 17 cases (85.0%).

Conclusion

Joint fusion was initially achieved at the uninjured posterior facet after subtalar arthrodesis due to traumatic arthritis caused by a displaced intraarticular calcaneal fracture. This suggests that meticulous surgical techniques and cannulated screw positioning at the uninjured site will promote joint fusion.

Keywords: Calcaneus, Fractures, intraarticular, Subtalar joint, Arthritis, Computed tomography, Arthrodesis

References

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Fig. 1.

Case of a 52-year-old male's radiologic image series undergoing subtalar arthrodesis. (A) The initial simple foot lateral X-ray shows an intraarticular calcaneal fracture. (B) The initial coronal view of the subtalar joint posterior facet in computed tomography (CT) image shows an intraarticular calcaneal fracture. The black line indicates the uninjured region and the white line indicates the injured region. (C) Simple lateral foot X-ray was performed after surgery. (D) The CT coronal view shows arthritic changes in the subtalar joint. (E) Simple lateral foot X-ray was performed after subtalar arthrodesis. The CT sagittal view shows partial union of the subtalar joint after subtalar arthrodesis (F), CT coronal view shows partial union of the subtalar joint after subtalar arthrodesis (G).

Fig. 2.

The fusion ratio was calculated by dividing the total sum of fused segment length, shown as the short dashed arrow, by the total sum of posterior subtalar joint length, shown as the long solid arrow.

Table 1.

Computed Tomography Ankle OA Grading Scale

Grade	Description
0	No clinical evidence of OA; joint space integrity fully intact
1	Mild; osteophyte formation/lipping present, with possible joint space narrowing
2	Moderate; joint space narrowing evident, with obvious osteophyte formation and some sclerosis/cystic changes
3	Severe; near absence of joint space, severe osteophyte/cyst formation, with deformity of bone

Data from the article of Cohen et al. (J Foot Ankle Surg 2015;54:207–213).

¹⁰ OA: osteoarthritis.

Table 2.

Summary of the Demographic Data, Radiologic and Clinical Results

No.	Sex/Age (yr)	side	Remark	Type*	Mechanism of Injury	BG†	Re-Op	Smoking	F/U period (mo)	Trauma to fusion (mo)	Arthritis grade	Union site	Fusion ratio	PreOp VAS	F/U VAS	PreOp AOFAS score	F/U AOFAS score
1	M/46	R	Open	IIIAB	FH	1	–	Yes	13	9	3	Uninjured	0.39	7	4	42	54
2	M/70	L	–	IV	TA	1	–	Yes	14	14	3	Uninjured	0.40	6	3	51	72
3	M/61	L	–	IV	FH		–	No	8	8	2	Uninjured	0.64	6	3	55	74
4	M/46	L	–	IV	FH		1	Yes	15	6	3	Uninjured	0.24	8	4	40	53
5	M/52	R	–	IIIAB	TA		–	No	20	16	3	Uninjured	0.40	6	4	43	54
6	M/54	R	–	IV	FH	2	–	Yes	7	6	3	Uninjured	0.54	7	3	56	74
7	M/59	R	Open	IIIAB	FH		–	Yes	13	10	3	Uninjured	0.59	6	3	58	75
8	F/36	L	Open	IV	FH	1	–	Yes	23	8	3	Both	0.68	6	2	57	82
9	F/16	L	Open	IV	FH	1	–	No	10	19	3	Both	0.98	6	1	54	89
10	M/56	R	Open	IIIAB	FH	2	–	Yes	9	7	3	Injured	0.36	6	3	61	76
11	M/58	R	–	IIIAB	FH	2	–	No	19	152	3	Uninjured	0.53	5	2	59	82
12	F/45	L	–	IIA	FH	2	–	No	11	12	2	Uninjured	0.51	5	2	56	80
13	F/44	R	Open-subtalar-dislocation	IV	FH	2	–	No	6	29	3	Uninjured	0.38	7	3	52	68
14	M/56	R	–	IV	FH	2	1	Yes	30	10	2	Uninjured	0.27	7	1	47	52
14	M/56	R	–	IIIAC	FH	2	1	No	48	11	3	Uninjured	0.28	7	3	46	54
15	M/57	L	–	IIA	FH		–	No	9	9	3	Uninjured	0.45	6	2	52	75
16	M/49	L	–	IV	FH	2	–	No	44	11	2	Uninjured	0.65	6	2	54	84
17	M/62	R	–	IIIAB	FH		–	Yes	16	9	3	Uninjured	0.59	6	2	55	81
18	M/43	R	–	IV	FH	2	1	Yes	40	25	3	Uninjured	0.21	7	5	41	52
18	M/43	L	Subtalar-dislocation	IIIAB	FH	2	–	Yes	48	18	3	Uninjured	0.36	7	3	56	69

Sandes classification of calcaneus fracture. †0, none; 1, autologous bone; 2, allogenous bone. BG: bone graft, Re-Op: re-operation, F/U: follow-up, PreOp: preoperative, VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society, M: male, F: female, R: right, L: left, FH: fall from height, TA: traffic accident

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