Non-union Subtalar Joint Fusion Infection – our Experience

Subtalar joint fusion with hardware is a well-known procedure and is preformed usually by an internal fixation. We present three cases of infected non-union which are treated few years following a failure with an external fixator.

Three patients aged 34-52 with an infected non-union appeared suffering from pain while walking. All three were males and removal of fixators and infection treatment was preformed prior to our engagement in the process. The infection was cured by prolonged antibiotic therapy and the bone scan showed a low probability of current infection. We chose an external fixator (a circular frame over the axis). During the surgery the joints were approached by a standard lateral approach. One patient needed an additional medial incision. The bony surfaces were prepared by the burr under direct vision. In one case an ultrasonic bone scalpel was used. Excision of bone wedges allowed proper alignment. This one was kept by an axis not connected to the frame. The frame allowed compression for four weeks and then the axis was removed.

Additional five weeks with FWB were sufficient for the fusion. The construction of the frame and possible surgical approaches allowing deformity correction with a novel posterior approach are presented.