Surgical Procedure
Posterolateral side of subtalar joint.
The posterior talar process is reduced with a shaver to be able to view the medial side of the subtalar joint.
Reduced posterior talar process and nice view of posterior talocalcaneal ligament.
The lateral side of the subtalar joint is visualized to make the portal in the sinus tarsi.
This is performed under direct vision; a spinal needle is introduced, directed posteromedially.
After skin incision, a blunt trocar is introduced in the same direction. This way making a false route can be prevented.
With a coalition, the space between talus and calcaneus is even more narrow than in case of osteoarthritis, and debridement will take more portal changes and time. Here a curette is introduced through the medial portal.
The cartilage is removed from the inferomedial side of the talus.
he lateral side of the subtalar joint can be debrided bes with the scope in the lateral portal, the trocar in the medial portal to keep the joint opened, and ....
...the curette in the sinus tarsi.
With a shaver the anterolateral area is further addressed.
Situation after cartilage removal.
With a 4mm chisel the talocalcaneal coalition is split.
ostimulate coaptation the subchondral bone is entered with a chisel in all areas of the subtalar joint.
For the smaller areas a microfracture probe can also be used.
The patient should now be bleeding from the bone.
Holes are drilled for the 2 lag screws.
Idem. After insertion of the screws the joint is coaptated and fusion can begin.