[Tibio-calcaneus fusion]

From January 1977 to August 1992 22 tibiocalcaneal fusions were performed at the Co-Operative Trade Association Hospital for Accidents, at Tübingen, Germany. 21 of these fusions healed both clinically and roentgenologically, the quality of the effected healing being stable. In more than two-thirds of the cases the indication for performing the fusion had been a fracture of the talus of the Weber/Marti IV or Hawkins III type with its associated complications. Hence, bony fusion between tibia and calcaneus is a commendably reliable treatment possibility in severe diseases of the talus and its adjacent articulations. The result can of course be only as good as the indication arrived at by the physician. In traumatology, this indication is mainly prompted by aseptic necrosis of the talus following talus fractures of maximum severity. A large number of relevant publications mentions an almost 100 per cent rate of necrosis associated with this lesion. This raises the very important question whether in case of such most severe forms of talus fracture it would not be better to aim at a primary tibio-calcaneal fusion straightway to save the patient the trouble of an otherwise prolonged course of the disease with doubtful outcome.