Umut YAVUZ, Sami SOKUCU, Bilal DEMİR, Devrim OZER, Cagri OZCAN, Yavuz S. KABUKCUOGLU

İhmal edilmiş ağrılı eklem içi kalkaneus kırıklarında izole subtalar füzyon

Amaç: Bu çalışmanın amacı eklem içi kalkaneus kırıklarına ikincil talokalkaneal artroz gelişen hastalarda subtalar artrodez tedavisinin radyolojik ve klinik sonuçlarını değerlendirmekti.Çalışma planı: 2005-2011 yılları arasında eklem içi kalkaneus kırığı nedeniyle konservatif tedavi uygulanan ve semptomatik subtalar artroz nedeniyle subtalar artrodez yapılan 20 hasta (21 ayak) çalışmaya alındı. On bir hastada otogreft veya allogreft kullanıldı. Hastaların klinik sonuçları American Orthopaedic Foot and Ankle Society (AOFAS) ayak bileği art-ayak skoru ile değerlendirildi. Art-ayak dizilimi, subtalar füzyonun kalitesi ve diğer eklemlerde oluşan artroz radyolojik olarak değerlendirildi.Bulgular: Ortalama takip süresi 43 (dağılım: 21-83) aydı. Cerrahi öncesi AOFAS skoru ortalama 61.7 (dağılım: 40-67) ve sonrası AOFAS skoru ortalama 84.2 (dağılım: 65-94) bulundu ve aradaki fark istatistiksel olarak anlamlıydı (p=0.001). Altı hastada mükemmel, 8 hastada iyi ve 6 hastada orta sonuç elde edildi. On dokuz hastada (20 ayak) tam füzyon sağlandı. İki hastada midtarsal eklemlerde radyolojik olarak artritik değişiklikler gözlenmekle birlikte bu değişiklikler semptomatik değildi. Cerrahi öncesi ve sonrası radyolojik ölçümler arasında istatistiksel olarak anlamlı fark saptanmadı. Yanlış kaynama gözlenen hasta olmadı.Çıkarımlar: Subtalar artrodez radyolojik ve klinik olarak belirgin fayda sağlamakla birlikte midtarsal eklemlerde orta derecede ve asemptomatik osteoartrite neden olabilmektedir.

Anahtar Kelimeler:

AOFAS; artrodez; greft; kalkaneus kırığı; subtalar artroz.

Isolated subtalar fusion for neglected painful intra-articular calcaneal fractures

Objective: The objective of this study was to evaluate the radiological and clinical outcomes of treatment of subtalar arthrodesis in patients developing talocalcaneal arthrosis secondary to intra-articular calcaneal fractures.Methods: The study included 20 patients (21 feet) who underwent subtalar arthrodesis due to symptomatic subtalar arthrosis following conservative treatment for intra-articular calcaneal fracture between 2005 and 2011. Autograft or allograft was used in 11 patients. Patients were evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Hindfoot alignment, quality of subtalar fusion and arthritis occurring in other joints were used for the radiological evaluations.Results: Mean duration of follow-up was 43 (range: 21 to 83) months. Mean preoperative AOFAS score was 61.7 (range: 40 to 67) and mean postoperative AOFAS score was 84.2 (range: 65 to 94). The difference between scores was statistically significant (p=0.001). Six patients had excellent, 8 good and 6 fair results. Complete fusion was achieved in 19 patients (20 feet). In 2 patients, arthritic changes were radiologically observed in the midtarsal joints. These changes were not symptomatic. There were no statistically significant differences between pre- and postoperative radiological measurements. No patients experienced malunion.Conclusion: While subtalar arthrodesis appears to provide radiological and clinical benefits, it may cause moderate and asymptomatic osteoarthritis in the midtarsal joints.

Keywords:

AOFAS, arthrodesis, calcaneal fracture, graft subtalar arthrosis,

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