Outcome of corrective osteotomy of shortened medial foot column after old talar neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Bibo ,  XU Xiangyang

Department of Orthopedics, Shanghai Ruijin Hospital, Medicine School of Shanghai Jiaotong University, Shanghai, 200025, P.R.China;

Corresponding author：

XU Xiangyang, Email: xu664531@hotmail.com

Keywords：

Talar neck fracture; mal-union; shortened medial foot column; osteotomy

DOI：

10.7507/1002-1892.201903091

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Objective To investigate the effectiveness of corrective osteotomy for shortened medial foot column after old talar neck fracture.Methods The clinical data of 10 patients with shortened medial foot column after old talar neck fracture between June 2012 and May 2017 was retrospectively analyzed. There were 7 males and 3 females with an average age of 45.8 years (mean, 21-67 years). The time from fracture to corrective osteotomy was 9-60 months (mean, 20.9 months). The preoperative visual analogue scale (VAS) score was 7.1±1.2, the American Orthopaedic Foot and Ankle Society (AOFAS) score was 48.5±12.3, and the short-form 36 health survey scale (SF-36) score was 46.7±10.5. All 10 cases received open wedge osteotomy of medial talus. Among them, 2 received subtalar fusion and Achilles tendon lengthening, 2 lateralizing calcaneal osteotomy, and 2 Achilles tendon lengthening.Results All incisions healed by first intention. All patients were followed up 13-72 months (mean, 38.0 months). The X-ray film showed that the angle between longitudinal axis of 1st metatarsal bone and talus increased from (−9.6±4.5) ° before operation to (1.3±2.7) ° at last follow-up (t=16.717, P=0.000); the angle between longitudinal axis of calcaneus and tibia increased from (−12.0±7.4) ° before operation to (−1.5±4.8) ° at last follow-up (t=5.711, P=0.000). At last follow-up, the VAS score, AOFAS score, and SF-36 score were 1.6±1.0, 88.3±5.4, and 85.4±9.2, respectively, which increased significantly when compared with the preoperative scores (t=13.703, P=0.000; t=14.883, P=0.000; t=16.919, P=0.000). X-ray film and CT showed that the osteotomy and arthrodesis sites healed well at 2-4 months after operation.Conclusion It’s a proper procedure of anatomic reduction and reconstruction for patients with shortened medial foot column and good articular cartilage morphology after old talar fracture. Opening wedge osteotomy of medial talus is recommended and can obtain satisfactory clinical and radiographic results.

Citation： WANG Bibo, XU Xiangyang. Outcome of corrective osteotomy of shortened medial foot column after old talar neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1345-1350. doi: 10.7507/1002-1892.201903091 Copy

1.	Rammelt S, Zwipp H. Talar neck and body fractures. Injury, 2009, 40(2): 120-135.
2.	Vallier HA, Nork SE, Barei DP, et al. Talar neck fractures: results and outcomes. J Bone Joint Surg (Am), 2004, 86(8): 1616-1624.
3.	Sanders DW, Busam M, Hattwick E, et al. Functional outcomes following displaced talar neck fractures. J Orthop Trauma, 2004, 18(5): 265-270.
4.	Ohl X, Harisboure A, Hemery X, et al. Long-term follow-up after surgical treatment of talar fractures: Twenty cases with an average follow-up of 7.5 years. Int Orthop, 2011, 35(1): 93-99.
5.	Sproule JA, Glazebrook MA, Younger AS. Varus hindfoot deformity after talar fracture. Foot Ankle Clin, 2012, 17(1): 117-125.
6.	Calvert E, Younger A, Penner M. Post talus neck fracture reconstruction. Foot Ankle Clin, 2007, 12(1): 137-151.
7.	Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin, 2004, 9(4): 723-736.
8.	Barg A, Suter T, Nickisch F, et al. Osteotomies of the talar neck for posttraumatic malalignment. Foot Ankle Clin, 2016, 21(1): 77-93.
9.	Alton T, Patton DJ, Gee AO. Classifications in brief: the Hawkins classification for talus fractures. Clin Orthop Relat Res, 2015, 473(9): 3046-3049.
10.	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(10): 1559-1567.
11.	Sangeorzan BJ, Wagner UA, Harrington RM, et al. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res, 1992, 10(4): 544-551.
12.	李博华, 黄富国, 刘雷. 陈旧性跟骨骨折的治疗进展. 中国修复重建外科杂志, 2017, 31(10): 1273-1277.
13.	Penny JN, Davis LA. Fractures and fracture-dislocations of the neck of the talus. J Trauma, 1980, 20(12): 1029-1037.
14.	Canale ST. Fractures of the neck of the talus. Orthopedics, 1990, 13(10): 1105-1115.
15.	Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg (Am), 1970, 52(5): 991-1002.
16.	王碧菠, 陈博, 李星辰, 等. 3D打印距骨部件修复重建距骨病损的生物力学研究. 中国修复重建外科杂志, 2018, 32(3): 306-310.
17.	Rammelt S, Winkler J, Heineck J, et al. Anatomical reconstruction of malunited talus fractures: a prospective study of 10 patients followed for 4 years. Acta Orthop, 2005, 76(4): 588-596.
18.	Whitaker C, Turvey B, Illical EM. Current concepts in talar neck fracture management. Curr Rev Musculoskeletal Med, 2018, 11(3): 456-474.
19.	王善玺, 李军, 黄富国, 等. 距下关节撑开植骨融合术在跟骨骨折畸形愈合治疗中的应用研究. 中国修复重建外科杂志, 2017, 31(6): 755-759.
20.	Monroe MT, Manoli A 2nd. Osteotomy for malunion of a talar neck fracture: a case report. Foot Ankle Int, 1999, 20(3): 192-195.
21.	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, 2013, 471(4): 1356-1364.
22.	Barg A, Harris MD, Henninger HB, et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int, 2012, 33(8): 655-661.
23.	Min W, Sanders R. The use of the mortise view of the ankle to determine hindfoot alignment: technique tip. Foot Ankle Int, 2010, 31(9): 823-827.
24.	Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int, 1995, 16(9): 572-576.
25.	Chan G, Sanders DW, Yuan X, et al. Clinical accuracy of imaging techniques for talar neck malunion. J Orthop Trauma, 2008, 22(6): 415-418.
26.	Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot. Foot Ankle Int, 2005, 26(10): 820-825.
27.	Seltzer SE, Weissman BN, Braunstein EM, et al. Computed tomography of the hindfoot. J Comput Assisted Tomogr, 1984, 8(3): 488-497.
28.	Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.
29.	Pagenstert GI, Barg A, Leumann AG, et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg (Br), 2009, 91(9): 1191-1196.
30.	Chen H, Liu W, Deng L, et al. The prognostic value of the hawkins sign and diagnostic value of MRI after talar neck fractures. Foot Ankle Int, 2014, 35(12): 1255-1261.
31.	Babu N, Schuberth JM. Partial avascular necrosis after talar neck fracture. Foot Ankle Int, 2010, 31(9): 777-780.

1. Rammelt S, Zwipp H. Talar neck and body fractures. Injury, 2009, 40(2): 120-135.
2. Vallier HA, Nork SE, Barei DP, et al. Talar neck fractures: results and outcomes. J Bone Joint Surg (Am), 2004, 86(8): 1616-1624.
3. Sanders DW, Busam M, Hattwick E, et al. Functional outcomes following displaced talar neck fractures. J Orthop Trauma, 2004, 18(5): 265-270.
4. Ohl X, Harisboure A, Hemery X, et al. Long-term follow-up after surgical treatment of talar fractures: Twenty cases with an average follow-up of 7.5 years. Int Orthop, 2011, 35(1): 93-99.
5. Sproule JA, Glazebrook MA, Younger AS. Varus hindfoot deformity after talar fracture. Foot Ankle Clin, 2012, 17(1): 117-125.
6. Calvert E, Younger A, Penner M. Post talus neck fracture reconstruction. Foot Ankle Clin, 2007, 12(1): 137-151.
7. Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin, 2004, 9(4): 723-736.
8. Barg A, Suter T, Nickisch F, et al. Osteotomies of the talar neck for posttraumatic malalignment. Foot Ankle Clin, 2016, 21(1): 77-93.
9. Alton T, Patton DJ, Gee AO. Classifications in brief: the Hawkins classification for talus fractures. Clin Orthop Relat Res, 2015, 473(9): 3046-3049.
10. 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(10): 1559-1567.
11. Sangeorzan BJ, Wagner UA, Harrington RM, et al. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res, 1992, 10(4): 544-551.
12. 李博华, 黄富国, 刘雷. 陈旧性跟骨骨折的治疗进展. 中国修复重建外科杂志, 2017, 31(10): 1273-1277.
13. Penny JN, Davis LA. Fractures and fracture-dislocations of the neck of the talus. J Trauma, 1980, 20(12): 1029-1037.
14. Canale ST. Fractures of the neck of the talus. Orthopedics, 1990, 13(10): 1105-1115.
15. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg (Am), 1970, 52(5): 991-1002.
16. 王碧菠, 陈博, 李星辰, 等. 3D打印距骨部件修复重建距骨病损的生物力学研究. 中国修复重建外科杂志, 2018, 32(3): 306-310.
17. Rammelt S, Winkler J, Heineck J, et al. Anatomical reconstruction of malunited talus fractures: a prospective study of 10 patients followed for 4 years. Acta Orthop, 2005, 76(4): 588-596.
18. Whitaker C, Turvey B, Illical EM. Current concepts in talar neck fracture management. Curr Rev Musculoskeletal Med, 2018, 11(3): 456-474.
19. 王善玺, 李军, 黄富国, 等. 距下关节撑开植骨融合术在跟骨骨折畸形愈合治疗中的应用研究. 中国修复重建外科杂志, 2017, 31(6): 755-759.
20. Monroe MT, Manoli A 2nd. Osteotomy for malunion of a talar neck fracture: a case report. Foot Ankle Int, 1999, 20(3): 192-195.
21. 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, 2013, 471(4): 1356-1364.
22. Barg A, Harris MD, Henninger HB, et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int, 2012, 33(8): 655-661.
23. Min W, Sanders R. The use of the mortise view of the ankle to determine hindfoot alignment: technique tip. Foot Ankle Int, 2010, 31(9): 823-827.
24. Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int, 1995, 16(9): 572-576.
25. Chan G, Sanders DW, Yuan X, et al. Clinical accuracy of imaging techniques for talar neck malunion. J Orthop Trauma, 2008, 22(6): 415-418.
26. Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot. Foot Ankle Int, 2005, 26(10): 820-825.
27. Seltzer SE, Weissman BN, Braunstein EM, et al. Computed tomography of the hindfoot. J Comput Assisted Tomogr, 1984, 8(3): 488-497.
28. Wang B, Saltzman CL, Chalayon O, et al. Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis? Clin Orthop Relat Res, 2015, 473(1): 318-325.
29. Pagenstert GI, Barg A, Leumann AG, et al. SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg (Br), 2009, 91(9): 1191-1196.
30. Chen H, Liu W, Deng L, et al. The prognostic value of the hawkins sign and diagnostic value of MRI after talar neck fractures. Foot Ankle Int, 2014, 35(12): 1255-1261.
31. Babu N, Schuberth JM. Partial avascular necrosis after talar neck fracture. Foot Ankle Int, 2010, 31(9): 777-780.

Chinese Journal of Reparative and Reconstructive Surgery

Outcome of corrective osteotomy of shortened medial foot column after old talar neck fracture

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