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Clin Orthop Relat Res. 2013 Apr;471(4):1356-64. doi: 10.1007/s11999-012-2649-0. Epub 2012 Oct 17.

Surgical technique: talar neck osteotomy to lengthen the medial column after a malunited talar neck fracture.

Author information

1
Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland. suter.thomas@gmx.net

Abstract

BACKGROUND:

Treatment of malunited talar neck fractures is challenging, and few studies address anatomic reconstruction as an alternative to arthrodesis. We describe a new surgical approach attempting to improve function and avoid development of degenerative changes in the adjacent joints.

DESCRIPTION OF TECHNIQUE:

Indications included malunited talar neck fractures. Through a dorsomedial approach, a correcting osteotomy with interposition of an autograft or allograft was performed and internally fixed using buttress plate and/or screws.

METHODS:

We retrospectively reviewed seven patients in whom the new technique was indicated for malunited talar neck fractures. The mean age of the patients was 42 years (range, 17-60 years). We analyzed the patients clinically and radiographically with a minimum followup of 2.5 years (mean, 4 years; range, 2.5-9.8 years).

RESULTS:

At followup, all patients experienced substantial pain relief. No development of avascular necrosis or radiographic arthritic changes were observed. Physical categories of the SF-36 score showed great improvements. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 41±19 preoperatively (range, 20-62) to 84±11 (range, 68-97). The average talar-first metatarsal angle increased dramatically. All but one patient showed radiographic union of the talar osteotomy. Implant removal was performed in three patients.

CONCLUSIONS:

Based on these observations, correctional osteotomy is a reasonable option for treating patients with malunited talar neck fractures by providing a pain-free foot with good function, recreating anatomy, and involving a low risk of postoperative complications. Further studies with longer followups are required to confirm these findings persist with time.

LEVEL OF EVIDENCE:

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

PMID:
23073707
PMCID:
PMC3586008
DOI:
10.1007/s11999-012-2649-0
[Indexed for MEDLINE]
Free PMC Article
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