Anatomical reconstruction of malunited talus fractures

Rammelt, Stefan; Winkler, J.; Heineck, J.; Zwipp, H.

doi:10.1080/17453670510041600

Cited by 54 publications

(14 citation statements)

References 37 publications

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“…Only the latter will lead to significantly inferior results while a certain amount of circulatory deficit may be seen on MRI in almost all displaced talar neck and body fractures. 8,11,12 …”

Section: Assessment and Classificationmentioning

confidence: 99%

“…In addition, patients need to be compliant with the postoperative protocol in order to benefit from joint-sparing surgery. 8 In Type I-III deformities, delayed anatomic reconstruction of the talus with preservation of all three joints can be attempted in reliable, active patients with sufficient bone stock. Patients with Type I-III deformities and severe, symptomatic posttraumatic arthritis can be salvaged with axial realignment and fusion, while preservation of either the ankle or subtalar joint should be attempted.…”

Section: Treatment Indicationsmentioning

confidence: 99%

“…5 -7, 14 We reported series of 10 patients treated with successful secondary reconstruction of talar malunions and nonunions, followed for an average of 4 years in 2005. 8 At the time of this writing, a total of 22 patients, 16 males and four females, at a mean age 30.5 (range, 15 to 50) years with painful malunions or non-unions were treated with secondary anatomic reconstruction at a mean of 9 (range, 1.5 to 45) months after sustaining a displaced fracture or fracturedislocation of the talar head, neck or body. Ten patients were classified as Type I, five as Type II, and seven as Type III.…”

Section: Treatment Indicationsmentioning

confidence: 99%

“…3,4,7 Malunited fractures of the talar body usually affect both the ankle and subtalar joints and are particularly difficult to treat. 8,15 The management of malunions and nonunions after fractures of the lateral and posterior process are beyond the scope of this article.…”

Section: Introductionmentioning

confidence: 99%

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Secondary Correction of Talar Fractures: Asking for Trouble?

Rammelt¹,

Zwipp²

2012

Foot Ankle Int.

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Secondary anatomical reconstruction of malunions or nonunions after talar fractures or fracture-dislocations with preservation of all three joints aims at maximal functional rehabilitation. A corrective osteotmy or revision of a pseudoarthrosis with axial realignment and internal fixation was carried out in 22 patients (aged 15 to 50) at a mean of 9 (range, 1.5 to 45) months after having sustained a fracture of the talar head, neck or body. 20 patients were followed for a mean of 4.8 (range, 1.5 to 14) years after reconstruction. No signs of development or progression of avascular necrosis (AVN) were observed in any case. Some amount of progression of peritalar arthritis was seen in 12 of 20 patients (60%). One patient required ankle fusion 7.5 years after reconstruction, another patient needed talo-navicular fusion after 5 years, and a third required a two-stage fusion of the ankle and the subtalar joint after 18 months. Two patients underwent arthrolysis of the ankle and screw removal after 7 and 14 years for dorsiflexion deficit at the ankle. The mean AOFAS ankle/hindfoot score increased from 36.9 preoperatively to 87.5 after correction (p < 0.001). Secondary correction after talar fractures appears promising in active and compliant patients without symptomatic arthritis, with good bone stock, no or partial AVN (less than one-third of the talar body), and no infection. Late fusion with a well-aligned talus remains a salvage option in cases of progressive arthritis.

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Section: Assessment and Classificationmentioning

confidence: 99%

Section: Treatment Indicationsmentioning

confidence: 99%

Section: Treatment Indicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Secondary Correction of Talar Fractures: Asking for Trouble?

Rammelt¹,

Zwipp²

2012

Foot Ankle Int.

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“…Nevertheless, anatomical reconstruction of nonunions and malunited talar fractures has been described in the literature; it appears attractive if the joint cartilage is still viable and if no talar collapse or infection has occurred. 17 According to Zwipp and Rammelt modified classification, 18 malunions or nonunions with no or partial avascular necrosis in an active and reliable patient with no symptomatic arthritis are appropriate for reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Talar Body Reconstruction for Nonunions and Malunions

Sakaki

Macedo

Santos

et al. 2018

IJOO

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Background:Talar body and neck nonunions and malunions may undergo a reconstructive surgery when joint cartilage is still viable, and no talar collapse or infection has occurred. This is a rare condition and the studies supporting the procedure have small number of cases. The objective of the present study is to report a case series of six patients who underwent talar reconstructions.Materials and Methods:Six patients with talar malunions or nonunions who underwent surgical treatment were reviewed in this retrospective study. There were three nonunions and two malunions of the talar body and one malunion of the talar neck. Clinical evaluation included all the parameters used in the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale. Arthritic degeneration of the ankle joint was assessed according to a modified Bargon scale.Results:The mean followup was 86 months (range 24-282 months). There were no cases of postoperative avascular necrosis of the talus. Four of the six patients in our series required a subtalar fusion as part of the reconstruction procedure. The average preoperative AOFAS hindfoot score was 34, and at the time of the last evaluation, it was 74. The mean preoperative score on the modified Bargon scale for the tibiotalar joint was 1.17. At the last followup, it rose to 1.33. Three different deformities of the talus were identified (a) flattening of the talus (b) extra-articular step and (c) intraarticular step.Conclusion:Reconstruction of talar nonunions and malunions improved function in selected patients with a low risk of complications. Three different anatomical patterns of talar nonunions and malunions were identified.

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Corrective Osteotomy for Talar Neck Malunions

Rammelt

Manke

2019

Revision Surgery of the Foot and Ankle

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Anatomical reconstruction of malunited talus fractures

Cited by 54 publications

References 37 publications

Secondary Correction of Talar Fractures: Asking for Trouble?

Secondary Correction of Talar Fractures: Asking for Trouble?

Talar Body Reconstruction for Nonunions and Malunions

Corrective Osteotomy for Talar Neck Malunions

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