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

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. 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. 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). 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 +/- A 19 preoperatively (range, 20-62) to 84 +/- A 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. 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 IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.