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Surgical Technique: Talar Neck Osteotomy to Lengthen the Medial Column After a Malunited Talar Neck Fracture

  • Surgical Technique
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Treatment of malunited talar neck fractures is challenging, and few studies address anatomic reconstruction as an alternative to arthrodesis. We describe a new surgical approach attempting to improve function and avoid development of degenerative changes in the adjacent joints.

Description of Technique

Indications included malunited talar neck fractures. Through a dorsomedial approach, a correcting osteotomy with interposition of an autograft or allograft was performed and internally fixed using buttress plate and/or screws.

Methods

We retrospectively reviewed seven patients in whom the new technique was indicated for malunited talar neck fractures. The mean age of the patients was 42 years (range, 17–60 years). We analyzed the patients clinically and radiographically with a minimum followup of 2.5 years (mean, 4 years; range, 2.5–9.8 years).

Results

At followup, all patients experienced substantial pain relief. No development of avascular necrosis or radiographic arthritic changes were observed. Physical categories of the SF-36 score showed great improvements. The American Orthopaedic Foot and Ankle Society hindfoot score increased from 41 ± 19 preoperatively (range, 20–62) to 84 ± 11 (range, 68–97). The average talar-first metatarsal angle increased dramatically. All but one patient showed radiographic union of the talar osteotomy. Implant removal was performed in three patients.

Conclusions

Based on these observations, correctional osteotomy is a reasonable option for treating patients with malunited talar neck fractures by providing a pain-free foot with good function, recreating anatomy, and involving a low risk of postoperative complications. Further studies with longer followups are required to confirm these findings persist with time.

Level of Evidence

Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Lilianna Bolliger MSc, for aid in the collection of the data and with preparation of the radiographic and intraoperative pictures.

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Authors and Affiliations

  1. Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, 4410, Liestal, Switzerland

    Thomas Suter MD, Alexej Barg MD, Markus Knupp MD & Beat Hintermann MD

  2. Harold K. Dunn Orthopaedic Research Laboratory, University Orthopaedic Center, University of Utah, Salt Lake City, UT, USA

    Heath Henninger PhD

Authors
  1. Thomas Suter MD
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  2. Alexej Barg MD
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  3. Markus Knupp MD
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  4. Heath Henninger PhD
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  5. Beat Hintermann MD
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Corresponding author

Correspondence to Thomas Suter MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangement etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Switzerland.

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Suter, T., Barg, A., Knupp, M. et al. Surgical Technique: Talar Neck Osteotomy to Lengthen the Medial Column After a Malunited Talar Neck Fracture. Clin Orthop Relat Res 471, 1356–1364 (2013). https://doi.org/10.1007/s11999-012-2649-0

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  • DOI: https://doi.org/10.1007/s11999-012-2649-0

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