A STUDY ON FUNCTIONAL OUTCOME OF MODIFIED TIBIOTALAR FUSION FOR POST TRAUMATIC AVASCULAR NECROSIS OF TALUS

Abstract

INTRODUCTION: Fractures of neck of the talus with or without dislocation of
subtalar joint and tibiotalar joint and talo-navicular are most devasting injuries that
can happen around the ankle joint. Most of these cases are complicated with
Avascular necrosis of talus and takes years to get revascularized even after
prolonged non weight bearing. Some surgeons Detenbeck and Kelly recommend
talectomy and tibio calcaneal compression arthrodesis as primary treatment but it
was found disadvantage of widening of hind foot and shortening of foot which makes
shoe fitting difficult. In modified tibio talar fusion in which the body of talus was
excised and a sliding cortical bone graft was positioned anteriorly between anterior
aspect of tibia and the head of talus. The advantages of this procedure is maintains
relatively normal appearance of the foot, maintainance of alignment, minimizing
shortening, and maximizing the remaining subtalar complex range of motion.
AIM: The main aim of this study is to evaluate the functional outcome of treated
cases by using American orthopaedic foot and ankle society (AOFAS) score and
visual analog scale (VAS) preoperatively and postoperatively and tibiopedal
movement was assessed postoperatively.
MATERIAL AND METHODS: Patients with Avascular necrosis of talus which
comes to orthopaedics department of GMC ongole from july 2024, will be included
in the study after meeting inclusion and exclusion criteria. Patients were reassesed at
6 weeks, 3 months and 6 months, 12 months post operatively using American
orthopaedic foot and ankle society (AOFAS) and VAS scoring.
RESULTS: In this study 84.6% patients were having excellent outcome and 15.3%
patients having good outcome. Preoperative AOFAS Score was 40.80 ± 13.26 which
was increased to significantly 87.57 ± 5.82 postoperatively and pain score VAS was
reduced from 6.61 ± 1.57 to 1.91 ± 0.99 indicating significant reduction in pain .
There was no limb length discrepancy.
CONCLUSION: The results are very good with modified blairs arthrodesis with
preservation of talus providing greater intraoperative stability