Local bone-graft technique for subtalar extraarticular arthrodesis in cerebral palsy

A modification of the subtalar extraarticular arthrodesis is described in which local bone graft from the calcaneus and talus is used with internal fixation to obtain fusion. Twenty-eight patients with cerebral palsy underwent 52 local bone-graft subtalar arthrodeses to correct valgus deformity of the hindfoot at an average age of 7 years 5 months. The preoperative lateral talocalcaneal angle averaged 44.5 degrees, with the intraoperative and postoperative angles being 35 and 33.5 degrees, respectively. These postoperative figures were significantly different from the preoperative films and remained stable over the average 41-month follow-up period. Six feet did not have radiographic union, yet only two lost correction requiring repeated surgery. Thus 88% of the feet had radiographic union, and 96% had a stable talocalcaneal angle at follow-up. This procedure is quick without the necessity of a distant bone graft and the inherent morbidity associated with it. It is as successful in stabilizing the subtalar joint as are other techniques reported in the literature.