J Korean Orthop Assoc.  2019 Feb;54(1):45-51. 10.4055/jkoa.2019.54.1.45.

Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor

• Park SH
• Lee JY
• Lee JW

• KMID: 2438961
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.45

Abstract

PURPOSE
The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively.
MATERIALS AND METHODS
From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed.
RESULTS
In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases.
CONCLUSION
An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

Keyword

talar neck fracture; medial malleolar osteotomy

MeSH Terms

Ankle
Arthritis
Follow-Up Studies
Foot
Hand
Humans
Magnetic Resonance Imaging
Neck*
Osteonecrosis
Osteotomy*
Retrospective Studies
Wound Infection

Figure

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  Figure 1 Intraoperative photograph shows the anteromedial approach and medial malleolar osteotomy.

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  Figure 2 Intraoperative photograph shows a large distractor for ankle distraction and fixation using a mini-plate on the superior portion of the deltoid ligament attachment site.

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  Figure 3 Last follow-up x-ray of the patient who showed the most severe radiologic posttraumatic ankle arthritic change. Preop., preoperative; Postop., postoperative; POD, postoperative day.

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  Figure 4 Images showing an example of a Hawkins sign and osteonecrosis on the talar dome. AVN, avascular necrosis.

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