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
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
- Maintain normal appearances foot
- Maintain alignment
- Minimizing shortening
- 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
