Surgical technique: talar neck osteotomy to lengthen the medial column after a malunited talar neck fracture.

BACKGROUND 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. DESCRIPTION OF TECHNIQUE 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. METHODS 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). RESULTS 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±19 preoperatively (range, 20-62) to 84±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. CONCLUSIONS 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 OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.