Posterior malleolus fractures are known to be caused by a combination of rotation and impaction, resulting in a wide variety of fractures, as published by Bartonicek. Among them is the subgroup known as the "posterior pilon variant," in which the axial impaction mechanism plays a fundamental role. There is no consensus regarding appropriate surgical approaches for these fractures. We describe a posteromedial modified approach, as an alternative to treat posterior pilon malleolar fractures. This approach can be performed safely, with low complication rates and generally with favorable outcomes.Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Avascular necrosis of the talus is a rare condition that can lead to important functional sequelae. There are few therapeutic alternatives for more advanced stages of this disease, the majority of which sacrifice the ankle joint. We report the case of a 50-year-old patient with nontraumatic avascular necrosis that compromised a large part of the talar surface. After non-structural autograft failed, it was reconstructed using fresh structural talar allograft. At one year of follow-up, the patient reported a considerable decrease in pain. To our knowledge, this is the first reported case in which fresh structural allograft was used in the treatment of nontraumatic avascular necrosis of the talus. Level of Evidence V; Therapeutic Studies; Expert Opinion.
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