Significant hindfoot deformity and morbidity can result from talar neck non-unions but are not often reported in the literature. Surgical management is evolving, with recent publications on the results of open reduction and internal fixation (ORIF) with bone grafting (BG), ankle fusion and modified Blair fusion. These authors report the clinical and radiological outcomes of a cohort of talar neck non-unions managed by ankle joint preserving reconstruction.
Eight patients (7 male and 1 female; mean age, 32.3 ± 13.1 years) with talar neck non-unions underwent ORIF+BG through dual approaches. Additional medial malleolar osteotomy was done in 2 cases, and calcaneofibular split approach to the subtalar joint in 3. Adjunct subtalar fusion was done in 5 cases. Clinical and radiological evaluation was performed pre- and post-operatively. Functional outcomes were assessed by the Manchester Oxford Foot Questionnaire (MOxFQ).
The mean surgical delay was 4.1 ± 1.7 months. As per Zwipp and Rammelt classification of post-traumatic talar deformities, 5 cases were classified as Type 3, 2 were Type 4, and 1 was Type 1. Union was achieved in 7 cases at a mean of 3.4 ± 1.3 months. One case had progressive collapse, which was managed by pantalar arthrodesis. All 3 cases where subtalar fusion was not performed primarily demonstrated subtalar arthrosis, but none required a secondary subtalar fusion. The MOxFQ score from 61.1 ± 10.1 to 41 ± 14.1 postoperatively (P = 0.005). The mean follow-up was 14.6 ± 6.8 months.
The authors concluded that ORIF+BG of the talar neck, with or without subtalar fusion has the potential to achieve solid union, correct the hindfoot deformity and improve functional outcomes. However, the long-term efficacy of this procedure is still unknown.
Source: Dhillon MS, Patel S, Sharma S. Clinical and radiological outcomes of ankle joint preserving surgical reconstruction for talar neck non-unions-A series of 8 cases. Injury. 2024;55 Suppl 2:111409. doi: 10.1016/j.injury.2024.111409.
