Talar Body Reconstruction for Nonunions and Malunions

• Published in: Indian journal of orthopaedics Vol. 52; no. 3; pp. 276 - 283
• Main Authors: Sakaki, Marcos Hideyo, Macedo, Rodrigo Sousa, Dos Santos, Alexandre Leme Godoy, Ortiz, Rafael Trevisan, Sposeto, Rafael Barban, Fernandes, Túlio Diniz
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-05-2018; Wolters Kluwer India Pvt. Ltd; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Ankle; Arthritis; Clinical outcomes; Conservative Orthopedics; Foot diseases; Fractures; Gangrene; Health aspects; Injuries; Medical imaging; Medicine; Medicine & Public Health; NMR; Nuclear magnetic resonance; Orthopedics; Pain; Patients; Plastic surgery; Postwar reconstruction; Reconstructive surgery; Skin & tissue grafts; Surgical Orthopedics; Symposium - Hindfoot and Ankle Trauma; Bone reconstruction; ankle injuries; ankle joint; Fracture fixation; malunion; nonunion; talar fracture; talar fracture MeSH terms: Fracture fixation; ankle joint; ankle injuries
• ISSN: 0019-5413; 1998-3727
• DOI: 10.4103/ortho.IJOrtho_423_17

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.