Anatomical reconstruction of malunited talus fractures: a prospective study of 10 patients followed for 4 years.
BACKGROUND
Malunions or nonunions after displaced talar fractures cause significant disability. Salvage procedures such as corrective arthrodesis do not restore normal foot function.


METHODS
Between 1994 and 2002, we treated 10 patients (aged 15-50 years) who had painful malunions with secondary anatomical reconstruction, at a mean of 1 year after sustaining displaced fractures of the talar body or neck. 5 patients were classified as type I (malunion and/or residual joint displacement), 2 as type II (nonunion with displacement) and 3 as type III (malunion with partial avascular necrosis, AVN). Correction was by an osteotomy through the malunited fracture or removal of the pseudarthrosis. Internal fixation was achieved with screws and additional bone grafting if necessary.


RESULTS
No wound healing problems or infections were seen. Solid union was obtained without redislocation in all cases, with no signs of development or progression of AVN. At a mean of 4 (1-8) years after reconstruction, all patients were satisfied with the result--except one patient who required ankle fusion 8 years after reconstruction. The mean AOFAS Ankle Hindfoot Score increased from 38 to 86 (p < 0.001).


CONCLUSIONS
Secondary anatomical reconstruction with joint preservation leads to considerable functional improvement in painful talar malunions. Partial AVN does not preclude good to excellent functional results. The quality of the bone stock and joint cartilage (rather than the time from injury) appears to be important for the choice of treatment.
Rammelt
Stefan
S
Trauma and Reconstructive Surgery, Carl Gustav Carus University Hospital, Dresden, Germany. strammelt@hotmail.com
Winkler
Jörg
J
Heineck
Jan
J
Zwipp
Hans
H
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome