INTRODUCTION: An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults. STEP 1 PREOPERATIVE PLANNING: Perform a comprehensive clinical and radiographic assessment. STEP 2 PATIENT POSITIONING: Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg. STEP 3 INCISION: Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal. STEP 4 APPROACH: Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons. STEP 5 JOINT PREPARATION: Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone. STEP 6 REDUCTION AND FIXATION: Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws. STEP 7 WOUND CLOSURE: Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position. STEP 8 POSTOPERATIVE CARE: The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks. RESULTS: Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications.
INTRODUCTION: An isolated subtalar arthrodesis through a sinus tarsi approach with cannulated screw fixation is safe, reproducible, and effective for specific hindfoot pathology in adults. STEP 1 PREOPERATIVE PLANNING: Perform a comprehensive clinical and radiographic assessment. STEP 2 PATIENT POSITIONING: Position the patient supine on the operating table with a bump under the ipsilateral hip, to internally rotate the involved leg. STEP 3 INCISION: Mark a longitudinal incision from just inferior to the tip of the lateral malleolus and extending toward the base of the 4th metatarsal. STEP 4 APPROACH: Expose the subtalar joint by reflecting the extensor digitorum brevis and protecting the peroneal tendons. STEP 5 JOINT PREPARATION: Meticulously prepare the subtalar joint using osteotomes and curets down to healthy bleeding subchondral bone. STEP 6 REDUCTION AND FIXATION: Reduce the subtalar joint into 5° of valgus and fix it with cannulated screws. STEP 7 WOUND CLOSURE: Meticulously close the wound in layers and place the lower leg in a well-padded plaster back slab with the ankle in a neutral position. STEP 8 POSTOPERATIVE CARE: The operatively treated leg is kept immobilized and non-weight-bearing for the first 6 weeks. RESULTS: Numerous retrospective articles have reported high fusion rates and good functional outcomes after isolated subtalar arthrodesis, for all indications.
Authors: Giovanni Romeo; Nicolò Martinelli; Carlo Bonifacini; Alberto Bianchi; Elena Sartorelli; Francesco Malerba Journal: J Foot Ankle Surg Date: 2015-07-23 Impact factor: 1.286