Skip to main content
SpringerLink
Log in

Talar Body Reconstruction for Nonunions and Malunions

  • Symposium - Hindfoot and Ankle Trauma
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

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) fattening 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sakaki MH, Saito GH, De Oliveira RG, Ortiz RT, Silva JD, Fernandes TD, et al. Epidemiological study on talus fractures. Rev Bras Ortop 2014;49:334–9.

    Article  Google Scholar 

  2. Young KW, Park YU, Kim JS, Cho HK, Choo HS, Park JH, et al. Misdiagnosis of talar body or neck fractures as ankle sprains in low energy traumas. Clin Orthop Surg 2016;8:303–9.

    Article  Google Scholar 

  3. Abdelgaid SM, Ezzat FF. Percutaneous reduction and screw fixation of fracture neck talus. Foot Ankle Surg 2012;18:219–28.

    Article  Google Scholar 

  4. Abdelkafy A, Imam MA, Sokkar S, Hirschmann M. Antegrade-retrograde opposing lag screws for internal fixation of simple displaced talar neck fractures. J Foot Ankle Surg 2015;54:23–8.

    Article  Google Scholar 

  5. Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the hawkins classification for talar neck fractures: Which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am 2014;96:192–7.

    Article  Google Scholar 

  6. Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, et al. Total talar fracture-long term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res 2012;98:S48–55.

    Article  CAS  Google Scholar 

  7. Xue Y, Zhang H, Pei F, Tu C, Song Y, Fang Y, et al. Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. Int Orthop 2014;38:149–54.

    Article  Google Scholar 

  8. Annappa R, Jhamaria NL, Dinesh KV, Devkant, Ramesh RH, Suresh PK. Functional and radiological outcomes of operative management of displaced talar neck fractures. Foot (Edinb) 2015;25:127–30.

    Article  Google Scholar 

  9. Beltran MJ, Mitchell PM, Collinge CA. Posterior to anteriorly directed screws for management of talar neck fractures. Foot Ankle Int 2016;37:1130–6.

    Article  Google Scholar 

  10. Stake IK, Madsen JE, Hvaal K, Johnsen E, Husebye EE. Surgically treated talar fractures. A retrospective study of 50 patients. Foot Ankle Surg 2016;22:85–90.

    Article  Google Scholar 

  11. Daniels TR, Smith JW, Ross TI. Varus malalignment of the talar neck. Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am 1996;78:1559–67.

    Article  CAS  Google Scholar 

  12. Sangeorzan BJ, Wagner UA, Harrington RM, Tencer AF. Contact characteristics of the subtalar joint: The effect of talar neck misalignment. J Orthop Res 1992;10:544–51.

    Article  CAS  Google Scholar 

  13. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long term evaluation of seventy-one cases. J Bone Joint Surg Am 1978;60:143–56.

    Article  CAS  Google Scholar 

  14. Frawley PA, Hart JA, Young DA. Treatment outcome of major fractures of the talus. Foot Ankle Int 1995;16:339–45.

    Article  CAS  Google Scholar 

  15. Gagneux E, Gerard F, Garbuio P, Vichard P. Treatment of complex fractures of the ankle and their sequellae using trans-plantar intramedullary nailing. Acta Orthop Belg 1997;63:294–304.

    CAS  PubMed  Google Scholar 

  16. Rockett MS, De Yoe B, Gentile SC, Zygmunt K. Nonunion of a Hawkin’s group II talar neck fracture without avascular necrosis. J Foot Ankle Surg 1998;37:156–61.

    Article  CAS  Google Scholar 

  17. Rammelt S, Winkler J, Heineck J, Zwipp H. Anatomical reconstruction of malunited talus fractures: A prospective study of 10 patients followed for 4 years. Acta Orthop 2005;76:588–96.

    Article  Google Scholar 

  18. Zwipp H, Rammelt S. Secondary reconstruction for malunions and nonunions of the talar body. Foot Ankle Clin 2016;21:95–109.

    Article  Google Scholar 

  19. Migues A, Solari G, Carrasco NM, González Della Valle A. Repair of talar neck nonunion with indirect corticocancellous graft technique: A case report and review of the literature. Foot Ankle Int 1996;17:690–4.

    Article  CAS  Google Scholar 

  20. Monroe MT, Manoli A 2nd. Osteotomy for malunion of a talar neck fracture: A case report. Foot Ankle Int 1999;20:192–5.

    Article  CAS  Google Scholar 

  21. Asencio G, Rebai M, Bertin R, Megy B, Daude O. Pseudarthrosis and nonunion of disjunctive talar fractures. Rev Chir Orthop Reparatrice Appar Mot 2000;86:173–80.

    CAS  PubMed  Google Scholar 

  22. Chen DW, Li B, Yang YF, Zhou JQ, Li HF, Aubeeluck A, et al. Clinical outcomes of surgical treatment for talar malunions and nonunions. Acta Ortop Bras 2013;21:226–32.

    Article  Google Scholar 

  23. Chen G, Hu M, Xu Y, Zhen YH, Hong Y, Xu XY, et al. Joint-preserving surgery for talar malunions or nonuions. Orthop Surg 2017;9:34–41.

    Article  Google Scholar 

  24. Huang PJ, Cheng YM. Delayed surgical treatment for neglected or mal-reduced talar fractures. Int Orthop 2005;29:326–9.

    Article  Google Scholar 

  25. Zwipp H, Gavlik M, Rammelt S. Secondary anatomical reconstruction of malunited central talus fractures. Unfallchirurg 2014;117:767–75.

    Article  CAS  Google Scholar 

  26. Suter T, Barg A, Knupp M, Henninger H, Hintermann B. Surgical technique: Talar neck osteotomy to lengthen the medial column after a malunited talar neck fracture. Clin Orthop Relat Res 2013;471:1356–64.

    Article  Google Scholar 

  27. Yu GR, Li B, Yang YF, Zhou JQ, Zhu XZ, Huang YG, et al. Surgical treatment of malunited or nonunited talus fractures. Zhonghua Wai Ke Za Zhi 2010;48:658–61.

    PubMed  Google Scholar 

  28. Zwipp H, Rammelt S. Posttraumatische korrekturoperationen am fuß. Zentralbl Chir 2003;128:218–2.

    Article  CAS  Google Scholar 

  29. Mahan KT, Lamy C. Surgical repair of a talar body nonunion. J Am Podiatr Med Assoc 1992;82:454–62.

    Article  CAS  Google Scholar 

  30. Calvert E, Younger A, Penner M. Post talus neck fracture reconstruction. Foot Ankle Clin 2007;12:137–51.

    Article  Google Scholar 

  31. Miller AN, Prasarn ML, Dyke JP, Helfet DL, Lorich DG. Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am 2011;93:1116–21.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Clinics Hospital HCFMUSP, Medicine College, University of Sao Paulo, Sao Paulo, Brazil

    Marcos Hideyo Sakaki, Rodrigo Sousa Macedo, Alexandre Leme Godoy Dos Santos, Rafael Trevisan Ortiz, Rafael Barban Sposeto & Túlio Diniz Fernandes

Authors
  1. Marcos Hideyo Sakaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodrigo Sousa Macedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Leme Godoy Dos Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rafael Trevisan Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rafael Barban Sposeto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Túlio Diniz Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcos Hideyo Sakaki.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakaki, M.H., Macedo, R.S., Dos Santos, A.L.G. et al. Talar Body Reconstruction for Nonunions and Malunions. IJOO 52, 276–283 (2018). https://doi.org/10.4103/ortho.IJOrtho_423_17

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ortho.IJOrtho_423_17

Keywords

MeSH terms

Search

Navigation