Subtalar Fusion in Cerebral Palsy Patients Results of a new technique using corticocancellous allogr

1
Subtalar Fusion in Cerebral Palsy Patients
Results of a new technique using
corticocancellous allograft

• Hakan Senaran, Mary Nagai, Kirk W Dabney, Freeman
  Miller,
• Alfred I duPont Hospital for Children, Delaware,
  USA
• Selcuk University Meram Faculty of Medicine,
  Konya, Turkey

2
Introduction

• Valgus deformity of the hindfoot in CP patients
  is common and causes functional deterioration and
  shoe fitting problems together with skin
  ulcerations.
• Subtalar arthrodesis serves to relieve pain and
  improve stability of the hindfoot by correcting
  the hindfoot deformity in symptomatic patients

3
Aims

• To present an intraarticular technique of
  subtalar fusion using tricortical iliac crest
  allograft and internal fixation to achieve
  stabilization
• To report the results and clinical outcome of a
  series of intraarticular subtalar arthrodesis
  performed in cerebral palsy children.

4
Materials and Methods

• 145 children with cerebral palsy
• Retrospective review of radiographs and medical
  records
• Underwent intraarticular subtalar fusion
• January of 1994 to December of 2004.

5
Materials and Methods

• The subtalar joint was fixed through the anterior
  facet after removal of the articular cartilage
  with a cannulated screw while the anterior aspect
  of the calcaneus was parallel to the anterior
  aspect of the head of the talus.

6
Materials and Methods

• Tricortical iliac crest allograft was placed into
  the sinus tarsi and the denuded posterior facet
  area.

7
Materials and Methods
8
Results

• The mean age at the time of surgery 12.9 years
  old (5-20)
• The average follow up 4.8 years (2-11).
• No deep infections, implant failure, allograft
  failure

9
Results

• Good results 242 feet (96)
• Satisfactory results 6 feet (2)
• Painless pseudoarthrosis of the subtalar joint 2
  feet
• Screw removal 4 feet (pain)
• Poor results 5 feet (2)
• Non union of the subtalar joint together with
  recurrence of the deformity required revision
  surgery.

10
Conclusion

• In conclusion, our described technique of
  intraarticular subtalar joint fusion with
  tricortical iliac crest allograft is safe and
  reliable in CP children with high rate of
  satisfactory results.