|
Year |
2007 |
|---|---|
|
Question Number |
183 |
|
Category |
Foot and Ankle |
Question
A 48-year-old man has severe ankle and hindfoot pain after being treated nonsurgically for an intra-articular calcaneal fracture 1 year ago. Examination reveals a shortened, widened heel with absent subtalar motion. The ankle dorsiflexes to neutral with pain. A lateral radiograph is shown in Figure 68. Treatment should now consist of
1- in situ subtalar fusion.
2- Achilles tendon lengthening.
3- distraction bone block subtalar fusion.
4- ankle fusion.
5- ankle and subtalar fusion.
Figures
Answer (click for answer)
Answer: 3- distraction bone block subtalar fusion.
The figure shows an incongruous subtalar joint and a decreased lateral talocalcaneal angle, which can cause tibiotalar neck impingement of not corrected. The most appropriate procedure includes a subtalar fusion with distraction of the subtalar joint, insertion of a bone block, and rigid screw fixation (choice 3). The distraction corrects the talocalcaneal relationship and regains lost hindfoot height. In situ subtalar fusion does not address the malalignment. Achilles tendon lengthening does not address the cause of the patient’s pain, and ankle fusion is not necessary as this joint is not involved (thus eliminating choices 4 and 5).
Reference:
