May 30, 2024

Grice Arthrodesis

Grice Arthrodesis is an extraarticular arthrodesis at subtalar joint.

It has little interference in growth so used in children

For the patient with no gross skeletal deformity but have instability to hind foot

Indications

  • Spastic paralysis in Cerebral palsy
  • Hindfoot valgus secondary to CP, Poliomyelitis, and other paralytic foot deformities
  • Calcano-valgus
  • Calcano-cavus
  • Talo calcaneal coalition
  • Congenital vertical talus
  • Isolated post-traumatic arthritis of subtalar joint

Radiographs

Lateral radiographs are important

Contraindications

  • Rigid deformed hindfoot
  • Much older children (>10 years) and adult with pathological hindfoot valgus
  • Not recommended for varus deformities
Grice arthodesis
Grice arthodesis

Blair Fusion

Blair fusion is done when inadequate bone remains and the salvage of ankle joint may be brought by realignment of tibiotalar joint and fusion of subtalar joint or by tibia calcaneal fusion with tricortical bone graft

To salvage cases of avascular collapse and degenerative cases in ankle and subtalar joint

Most common Indication: AVN due to talar neck fracture

Pre-requisites

Patient with adequate remaining talar neck to receive the tibial graft

Advantages

  1. Maintain normal appearances foot
  2. Maintain alignment
  3. Minimizing shortening
  4. Maximizing the remaining subtalar complex ROM

Surgical Techniques

Performed through an anterolateral approach

Talar body discarded

A foot placed in 10-15 degrees of equinus

A sliding bone graft from the anterior aspect of tibia is inserted into talar neck to reestablish limb continuity while maintaining some hindfoot motion

ICBG: To augment fusion

Augmented by posterior tibial cancellous screw into talar head

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