Talar Body Reconstruction for Nonunions and Malunions

Abstract

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.

Parameters That Can Be Used to Quantify Reduction Accuracy in Talar Neck Fractures and Malunions: A PRISMA-Compliant Scoping Review and Meta-Analysis

“…Correction of a talar neck malunion necessitates a talar neck osteotomy and restoration of the medial neck length employing an interposition graft. The few published studies on talar neck malunion [36][37][38][39][40], while reporting the 'varus deformity', did not quantify its three-dimensional anatomy nor report the correction that was achieved post-operatively. We believe that the DA and TA are useful parameters to quantify the degree of varus and internal rotation of the neck in a talar malunion respectively.…”

Parameters for assessment of talar neck geometry: a protocol for scoping literature review

“…The literature on talar neck malunions is limited to description of the varus nature of the deformity and its surgical correction (4)(5)(6). The geometrical parameters that describe the three-dimensional anatomy of the talar neck are sparsely reported.…”

Complex Hindfoot and Ankle Trauma: The Management Status in 2018

“… 11 This fairly frequent complication involving the talar body is addressed by Sakaki et al . 12 in this issue, who give their experience of reconstructing six such cases, where the articular cartilage was intact, and the bone was thus reconstructable. They identified three different patterns of talar nonunions and malunions, and suggest adding a subtalar fusion to the reconstruction to improve the vascularity, which allowed them to successfully avoid avascular necrosis of the talus in all their cases.…”