Different fixation techniques have been described in the literature for isolated subtalar arthrodesis (ISA). The purpose of this study was to compare the fusion rate and clinical outcome of ISA using cannulated compression screws or compression staples.
Methods:
Thirty-three patients (33 feet) underwent ISA using screw (17 feet) or staples (16 feet) fixation. Patients were followed for 42.7 ± 16.4 months (range, 24.5-84.3 months). The subtalar fusion was assessed radiographically and clinically. Clinical outcome measures included the visual analog scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.
Results:
The average pain score decreased significantly from 6.4 ± 1.1 (range, 5-9) to 0.8 ± 1.3 (range, 0-4) (P < .001). In the screws group, the average AOFAS hindfoot score increased significantly from 54.6 ± 8.8 (range, 37-67) preoperatively to 86.1 ± 7.1 (range, 71-91) postoperatively (P < .001). In the staples group, the average AOFAS hindfoot score increased significantly from 53.4 ± 11.1 (range, 33-69) preoperatively to 83.4 ± 6.9 (range, 71-91) postoperatively (P < .001). The AOFAS hindfoot score was comparable in both groups (P = .149). Only the AOFAS hindfoot score function subgroup in the screw fixation was significantly higher than in the staples fixation group (P = .005). There were 4 cases of nonunion at the site of subtalar arthrodesis (2 from screws group, 2 from staples group). The complication rate was comparable in both groups.
Conclusion:
The fusion rate was comparable in both groups, while the postoperative functional outcome was significantly better in the screw fixation group.
Level of Evidence:
Level III, retrospective comparative cohort study.
AmendolaALammensP. Subtalar arthrodesis using interposition iliac crest bone graft after calcaneal fracture. Foot Ankle Int. 1996;17(10):608-614.
2.
AmendolaALeeKBSaltzmanCLSuhJS. Technique and early experience with posterior arthroscopic subtalar arthrodesis. Foot Ankle Int. 2007;28(3):298-302.
3.
BednarzPABealsTCManoliA.Subtalar distraction bone block fusion: an assessment of outcome. Foot Ankle Int. 1997;18(12):785-791.
4.
BetzMWieserKVichMWirthSHEspinosaN. Precision of targeting device for subtalar screw placement. Foot Ankle Int. 2012;33(6):519-523.
5.
BoffeliTJReinkingRR. A 2-screw fixation technique for subtalar joint fusion: a retrospective case series introducing a novel 2-screw fixation construct with operative pearls. J Foot Ankle Surg. 2012;51:734-738.
6.
BuchBDMyersonMSMillerSD.Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures. Foot Ankle Int. 1996;17(2):61-70.
7.
BurtonDCOlneyBWHortonGA. Late results of subtalar distraction fusion. Foot Ankle Int. 1998;19(4):197-202.
CerratoRAAiyerAACampbellJJengCLMyersonMS. Reproducibility of computed tomography to evaluate ankle and hindfoot fusions [published online ahead of print July 23, 2014]. Foot Ankle Int.
10.
ChahalJStephenDJBulmerBDanielsTKrederHJ. Factors associated with outcome after subtalar arthrodesis. J Orthop Trauma. 2006;20:555-561.
11.
ChandlerJTBonarSKAndersonRBDavisWH. Results of in situ subtalar arthrodesis for late sequelae of calcaneus fractures. Foot Ankle Int. 1999;20(1):18-24.
12.
ChiangCCTzengYHLinCF. Subtalar distraction arthrodesis using fresh-frozen allogeneic femoral head augmented with local autograft. Foot Ankle Int. 2013;34(4):550-556.
13.
ChuckpaiwongBEasleyMEGlissonRR. Screw placement in subtalar arthrodesis: a biomechanical study. Foot Ankle Int. 2009;30(2):133-141.
14.
DahmDLKitaokaHB. Subtalar arthrodesis with internal compression for post-traumatic arthritis. J Bone Joint Surg Br. 1998;80:134-138.
15.
DaviesMBRosenfeldPFStavrouPSaxbyTS. A comprehensive review of subtalar arthrodesis. Foot Ankle Int. 2007;28(3):295-297.
16.
DecarboWTBerletGCHyerCFSmithWB. Single-screw fixation for subtalar joint fusion does not increase nonunion rate. Foot Ankle Spec. 2010;3:164-166.
17.
DennysonWGFulfordGE. Subtalar arthrodesis by cancellous grafts and metallic internal fixation. J Bone Joint Surg Br. 1976;58-B:507-510.
18.
DieziCFavrePVienneP. Primary isolated subtalar arthrodesis: outcome after 2 to 5 years followup. Foot Ankle Int. 2008;29(12):1195-1202.
19.
EasleyMETrnkaHJSchonLCMyersonMS. Isolated subtalar arthrodesis. J Bone Joint Surg Am. 2000;82:613-624.
20.
FlemisterASJrInfanteAFSandersRWWallingAK. Subtalar arthrodesis for complications of intra-articular calcaneal fractures. Foot Ankle Int. 2000;21(5):392-399.
GlanzmannMCSanhueza-HernandezR.Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases. Foot Ankle Int. 2007;28(1):2-7.
23.
GoschCVerretteRLindseyDPBeaupreGSLehnertB. Comparison of initial compression force across the subtalar joint by two different screw fixation techniques. J Foot Ankle Surg. 2006;45:168-173.
24.
HaskellAPfeiffCMannR. Subtalar joint arthrodesis using a single lag screw. Foot Ankle Int. 2004;25(11):774-777.
25.
HintermannBValderrabanoVNiggB. Influence of screw type on obtained contact area and contact force in a cadaveric subtalar arthrodesis model. Foot Ankle Int. 2002;23(11):986-991.
26.
HuangPJChenSKChenYWChengYMLinSYHsuCY. Subtalar arthrodesis for subtalar arthritis. Kaohsiung J Med Sci. 1997;13:677-681.
HuskissonEC.Measurement of pain. Lancet. 1974;2:1127-1131.
29.
JohnsonJECohenBEDigiovanniBFLamdanR. Subtalar arthrodesis with flexor digitorum longus transfer and spring ligament repair for treatment of posterior tibial tendon insufficiency. Foot Ankle Int. 2000;21(9):722-729.
30.
JoveniauxPHarisboureAOhlXDehouxE. Long-term results of in situ subtalar arthrodesis. Int Orthop. 2010;34:1199-1205.
31.
KitaokaHBAlexanderIJAdelaarRSNunleyJAMyersonMSSandersM. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, lesser toes. Foot Ankle Int. 1994;15(7):349-353.
32.
LaportaGBockFGhateN. Posterior approach for subtalar joint distraction arthrodesis by compact external fixation: a technique guide. J Foot Ankle Surg. 2013;52:547-552.
33.
LeeJJPatelRBiermannJSDoughertyPJ. The musculoskeletal effects of cigarette smoking. J Bone Joint Surg Am. 2013;95:850-859.
34.
LorenzoVBoronatMSaavedraP. Disproportionately high incidence of diabetes-related end-stage renal disease in the Canary Islands: an analysis based on estimated population at risk. Nephrol Dial Transplant. 2010;25:2283-2288.
MeyerMSAlvarezBENjusGOBennettGL. Triple arthrodesis: a biomechanical evaluation of screw versus staple fixation. Foot Ankle Int. 1996;17(12):764-767.
37.
NicholsonRHCrawleyFP. Revising the declaration of Helsinki: a fresh start. Bull Med Ethics. 1999;151:13-17.
38.
PayetteCRSageRAGonzalezJVSartoriMPatwardhanAVrbosL. Triple arthrodesis stabilization: a quantitative analysis of screw versus staple fixation in fresh cadaveric matched-pair specimens. J Foot Ankle Surg. 1998;37:472-480.
39.
PinskerEDanielsTR. AOFAS position statement regarding the future of the AOFAS clinical rating systems. Foot Ankle Int. 2011;32(9):841-842.
40.
RammeltSGrassRZawadskiTBiewenerAZwippH. Foot function after subtalar distraction bone-block arthrodesis: a prospective study. J Bone Joint Surg Br. 2004;86:659-668.
SijbrandijESVan GilsAPVan HellemondtFJLouwerensJWDe LangeEE. Assessing the subtalar joint: the broden view revisited. Foot Ankle Int. 2001;22(4):329-334.
43.
ThaunatMBajardXBoisrenoultPBeaufilsPOgerP. Computer tomography assessment of the fusion rate after posterior arthroscopic subtalar arthrodesis. Int Orthop. 2012;36:1005-1010.
44.
ThermannHHufnerTSchrattEHeldCVon GlinskiSTscherneH. Long-term results of subtalar fusions after operative versus nonoperative treatment of os calcis fractures. Foot Ankle Int. 1999;20(7):408-416.
45.
ThomasFB.Arthrodesis of the subtalar joint. J Bone Joint Surg Br. 1967;49:93-97.
46.
TuijthofGJMBeimersLKerkhoffsGMDankelmanJVan DijkCN. Overview of subtalar arthrodesis techniques: options, pitfalls and solutions. Foot Ankle Surg. 2010;16:107-116.
47.
WeltmerJBJrCracchioloAIII. The use of the powered metaphyseal stapler for reconstructive procedures in the adult foot. Foot Ankle. 1990;11(1):12-15.
