Osteotomy for Malunion of a Talar Neck Fracture: A Case Report

Abstract

A malunion of the talar neck after a Hawkins type II fracture/dislocation of the talar neck occurred in a 34-year-old man after nonoperative treatment. Rigid varus deformity of the forefoot was a source of severe pain and disability in this patient. We describe our surgical technique for osteotomy of the talar neck with insertion of a tricortical iliac crest bone graft to correct the deformity. At follow-up (56 months), the patient had consistent relief of pain and was employed at his preinjury job doing heavy labor. The score on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale improved from 11 points, preoperatively, to 85 points, postoperatively. Radiographs showed maintenance in the position of the osteotomy and no evidence of avascular necrosis in the talar body. Evidence of arthrosis of the talonavicular joint was apparent radiographically, but the patient did not complain of symptoms referable to this area.

Anatomical reconstruction of malunited talus fractures

“…However, this has been reported only anecdotally in the medical literature. Monroe and Manoli (1999) successfully corrected one case of malunion of the talar neck by osteotomy and corticocancellous bone grafting. Mahan and Lamy (1992) treated one case of talar neck nonunion with considerable displacement 9 months after the injury with open reduction and internal fixation of the fracture.…”

“…Anatomical reconstruction of malunited talar fractures thus appears attractive if the joint cartilage is still viable, and no talar collapse or infection has occurred. To date, surgical restoration of the anatomical shape of the talus after malunion of a displaced body or neck fracture with preservation of the essential joints has only been reported anecdotally (Zwipp et al 1998, Monroe and Manoli 1999, Hansen 2000. We hypothesized that near-normal foot function can be restored in cases of residual deformity after overlooked or improperly treated talus fractures with axial malalignment and joint incongruity.…”

The treatment of haemophilic intraosseous bone cyst of the talus

“…The authors found no reports of a true osteochondral bone graft. Many examples of bone grafts exist (Monroe & Manoli 1999). Draper and Fallat (2000) reported an osteochondral bone graft, but the cartilage used to cover the bone-grafted defect was the chondrolytic cartilage that was present within the joint.…”

Talar neck fractures: results and complications by type

“…Rigid internal fixation followed by early motion could improve this complication, but Peterson et al [16] have reported that early motion favours non-union. Osteotomy of the talar neck, bone grafting and peritalar arthrodesis have been suggested to correct the deformity [17,18].…”