Central talar fractures—therapeutic considerations

Cronier, P.; Talha, A.; Massin, P.

doi:10.1016/j.injury.2004.07.009

Cited by 63 publications

(27 citation statements)

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“…1) of properly selected type I-III malunions and nonunions of the talar head, neck and body is carried out through the same surgical approaches that are used in acute fractures [5,14,16,20]. The talar neck and head are exposed via an anteromedial approach.…”

Section: Techniquesmentioning

confidence: 99%

“…For full exposure of the talar dome, a medial malleolar osteotomy is added. The lateral part of the talar neck and body including the lateral process and subtalar joint are accessed via a curved or oblique anterolateral approach [20]. Posterior approaches are used for malunions of the posterior process or the posterior third of the talar body [5,6].…”

Section: Techniquesmentioning

confidence: 99%

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Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

Rammelt

Zwipp

2013

International Orthopaedics (SICOT)

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Hindfoot malunions after fractures of the talus and calcaneus lead to severe disability and pain. Corrective osteotomies and arthrodeses aim at functional rehabilitation and reduction of pain resulting from post-traumatic arthritis, eccentric loading and impingement due to hindfoot malunion. Preoperative analysis should include the three-dimensional outline of the malunion, the presence of post-traumatic arthritis, non-union, or infection, the extent of any avascular necrosis or comorbidities. In properly selected, compliant patients with intact cartilage cover little or no, AVN, and adequate bone quality, a corrective joint-preserving osteotomy with secondary internal fixation may be carried out. In the majority of cases, realignment is augmented by arthrodesis for post-traumatic arthritis. Fusion is restricted to the affected joint(s) to minimise loss of function. Correction of the malunion is achieved by asymmetric joint resection, distraction and structural bone grafting with corrective osteotomies for severe axial malalignment. Bone grafting is also needed after resection of a fibrous non-union, sclerotic or necrotic bone. Numerous clinical studies have shown substantial functional improvement and high subjective satisfaction rates from pain reduction after corrective osteotomies and fusions for post-traumatic hindfoot malalignment. This article reviews the indications, techniques and results of corrective surgery after talar and calcaneal malunions and nonunions based on an easy-to-use classification.

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Section: Techniquesmentioning

confidence: 99%

Section: Techniquesmentioning

confidence: 99%

Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results

Rammelt

Zwipp

2013

International Orthopaedics (SICOT)

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“…Screws are used most frequently for fixation of talar neck fractures; however, in cases of comminuted fracture types, they may induce excessive compression [4], so malunion and subsequent osteoarthritis and stiffness of the joint will occur [5].…”

Section: Introductionmentioning

confidence: 99%

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Xue

Zhang

Pei

et al. 2013

International Orthopaedics (SICOT)

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Purpose Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. Methods In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. Results Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Posttraumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85). Conclusions Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.

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“…Het draagt het totale lichaamsgewicht over op de voor-en achtervoet (van de tibia op de calcaneus en het os naviculare). De talus articuleert met de tibia, de fibula, de calcaneus en het os naviculare (3,5,12).…”

Section: Ossaalunclassified

“…Er hechten geen spieren op de talus aan, de talus beweegt dus passief in zijn positie tussen het tibiotalaire, subtalaire en talonaviculaire gewricht. Banden aan de fibula, mediale malleolus, de calcaneus en het os naviculare zorgen voor een stabiele positie (3,5,(12)(13). Anatomisch zijn een een hals, een corpus en een kop te onderscheiden.…”

Section: Ossaalunclassified