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.
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.
Authors: David W Sanders; Matthew Busam; Emily Hattwick; John R Edwards; Mark P McAndrew; Kenneth D Johnson Journal: J Orthop Trauma Date: 2004 May-Jun Impact factor: 2.512
Authors: Heather A Vallier; Sean E Nork; David P Barei; Stephen K Benirschke; Bruce J Sangeorzan Journal: J Bone Joint Surg Am Date: 2004-08 Impact factor: 5.284