[The Grice-Green subtalar arthrodesis using a fibular bone graft--follow-up of 92 patients]. / Die extraartikuläre Arthrodese nach Grice und Green mit Implantation eines Fibulaspans--Nachuntersuchung von 92 Patienten.

ABSTRACT

BACKGROUND: The Grice-Green subtalar arthrodesis is considered to be a valid treatment option of severe pes planovalgus deformity especially in children with cerebral palsy. The purpose of this study was to evaluate long term results using Grice-Green procedure with a fibular bone graft. MATERIAL AND METHODS: Between 3/07 and 11/12 92 patients (36 girls, 56 boys) with 127 feet underwent surgery. The average age of patients was 12.3 years (5-21 years). 68 patients had infantile cerebral palsy, 17 patients suffered from other neuromuscular diseases and 7 had idiopathic pes planovalgus deformities. The preoperative and postoperative radiographs with full weight bearing in the frontal and lateral planes were analysed. The mean follow-up was 22.6 months (6-64 months). In addition to that, 23 of the 92 patients (13 girls, 10 boys) were reviewed preoperatively, in the first year after operation and after more than 24 months. RESULTS: The mean lateral talocalcanear angle was reduced from 49.52 to 31.49°. The calcaneal pitch angle changed from 2.95 to 7.55°. The mean lateral talo-first-metatarsal angle improved from -36.98 to -12.32°. The mean frontal talo-first-metatarsal-base-angle increased from -28.48 to -2.64° and the TMT index from -66.46 to -14.96°. All measured angles changed significantly (p < 0.0001). There was no significant change after 6-12 month and ≥ 24 month follow-up (p > 0.05). Eight feet were not corrected completely, three feet were overcorrected. In one case the fibular graft was reabsorbed. There were degenerative changes of the talus in three cases. 14 feet developed a dorsal bunion with extension deformity of the first metatarsal bone. CONCLUSIONS: The Grice-Green subtalar arthrodesis improves foot alignment and can achieve a significant correction also in long-term follow-up.