title: [Secondary anatomical reconstruction of malunited central talus fractures].
abstract: BACKGROUND
  Malunion or nonunion of central talar fractures lead to significant impairment, pain and decreased motion of the foot and ankle. In a 20-year period from 1994 to 2013 at the Trauma Department of the University Hospital Carl Gustav Carus of the Technical University of Dresden we treated a total of 25 patients with secondary anatomical reconstruction of the talus.
  
  
  METHODS
  The mean age of the patients was 39.9 years (range 15-71 years) and only 4 out of the 25 patients were female. Of these patients 11 patients were treated conservatively, 3 minimally invasive with external fixation and were admitted on average 7.6 months (range 1.5-42 months) after the initial fracture. Of the patients 11 had previously been treated in another hospital by open surgery on average 8.4 months (range 1-24 months) months before. There were 9 malunions or nonunions of talar fractures of the shaft, 14 of the neck and 2 of the head. Only 3 cases were old fractures ≥ 6 weeks and 22 were malunions or nonunions ≥ 3 months. According to an in-house classification 12 malunions (type I), 5 nonunions (type II), and 8 malunions/nonunions with partial necrosis (type III) were treated.
  
  
  RESULTS
  Of the patients 21 out of 25 needed a bilateral approach and 6 additionally an osteotomy of the medial malleolus.The mean follow-up of 22 out of 25 patients was 5.4 years (range 1.0-21.5 years). The preoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score increased on average from 36.6 to 86.7 points (p<0.001) at the time of follow-up.
authors.affiliation: Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Anstalt öffentlichen Rechts des Freistaates Sachsen, Fetscherstraße 74, 01307, Dresden, Deutschland, Hans.Zwipp@uniklinikum-dresden.de.
authors.forename: H
authors.initials: H
authors.lastname: Zwipp
authors.forename: M
authors.initials: M
authors.lastname: Gavlik
authors.forename: S
authors.initials: S
authors.lastname: Rammelt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D017759:Fractures, Malunited / Q000175:diagnosis / Q000601:surgery*; D005599:Fractures, Ununited / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012086:Reoperation / Q000379:methods; D013628:Talus / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult