Abd-Ella Mohamed Mokhtar, Galhoum Ahmed, Abdelrahman Amr Farouk, Walther Markus
1 Ain Shams University, Orthopedic Surgery, Cairo, Egypt.
2 Schmerzklinik Kirschgarten, Orthopedics Surgery Hirschgasslein, Basel, Switzerland.
Foot Ankle Int. 2017 Aug;38(8):879-884. doi: 10.1177/1071100717709574. Epub 2017 Jun 6.
The presence of nonunion of a talar fracture with displacement, together with complete avascular necrosis, is a challenging entity to treat.
Twelve patients, 8 men (66.7%) and 4 women (33.3%), with nonunited talar fractures and extensive avascular necrosis of the talus were included. The average age was 27.7 years (range, 19-38 years). After exclusion of infection, the patients underwent resection of necrotic bone, bulk autograft, and fusion using an intramedullary nail. The posterior approach was used in 11 patients and the anterior approach in 1 patient. The primary outcome was solid osseous union at the ankle and subtalar level and between the talar head anteriorly and the posterior construct, as evidenced by computed tomographic examination. Functional assessment was performed with the American Orthopaedic Foot & Ankle Society score and subjective patient satisfaction Results: After a mean follow-up duration of 23 months (range, 12-60 months), solid osseous union was achieved in 8 patients (66.7%). Stable fibrous union was seen in 1 patient (8.3%). Three patients (25%) required reoperation, and osseous fusion was finally achieved. American Orthopaedic Foot & Ankle Society score improved from a mean of 39.3 (range, 12-56) preoperatively to 76.6 (range, 62-86) at last follow-up. Subjective patient satisfaction was graded good or excellent in all cases.
Resection of necrotic talar body and bulk autograft with tibiotalocalcaneal fusion by an intramedullary nail through a posterior approach was a reasonable option for the management of type IV posttraumatic talar deformity.
Level IV, case series.
距骨骨折伴移位且不愈合，同时合并完全性缺血性坏死，是一种治疗颇具挑战性的情况。
纳入12例距骨骨折不愈合且距骨广泛缺血性坏死的患者，其中男性8例（66.7%），女性4例（33.3%）。平均年龄27.7岁（范围19 - 38岁）。排除感染后，患者接受坏死骨切除、大块自体骨移植，并使用髓内钉进行融合。11例患者采用后入路，1例患者采用前入路。主要结局是通过计算机断层扫描检查证明在踝关节和距下关节水平以及距骨头部前方与后方结构之间实现牢固的骨愈合。采用美国矫形足踝协会评分和患者主观满意度进行功能评估。结果：平均随访23个月（范围12 - 60个月）后，8例患者（66.7%）实现了牢固的骨愈合。1例患者（8.3%）出现稳定的纤维性愈合。3例患者（25%）需要再次手术，最终实现了骨融合。美国矫形足踝协会评分从术前平均39.3（范围12 - 56）提高到末次随访时的76.6（范围62 - 86）。所有病例患者主观满意度均为良好或优秀。
通过后入路采用髓内钉进行坏死距骨体切除、大块自体骨移植及胫距跟融合，是治疗IV型创伤后距骨畸形的合理选择。
IV级，病例系列。
