Foot and Ankle Biomechanics, Experimentation and Research (FABER) Laboratory, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Foot and Ankle Biomechanics, Experimentation and Research (FABER) Laboratory, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Injury. 2024 Jun;55 Suppl 2:111409. doi: 10.1016/j.injury.2024.111409. Epub 2024 Aug 2.
Talar neck non-unions result in significant hindfoot deformity and morbidity and are infrequently reported in the literature. The optimal surgical management for this condition is evolving, with various authors reporting the results of open reduction and internal fixation (ORIF) with bone grafting (BG), ankle fusion and modified Blair fusion. We performed this study to report the clinical and radiological outcomes of a cohort of talar neck non-unions managed by ankle joint preserving reconstruction.
This was an ambispective study which included 8 patients (7 male and 1 female) with talar neck non-unions. All patients 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 age of patients 32.3 ± 13.1 years. 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.
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, larger studies with longer follow-up are needed to evaluate the long-term efficacy of this procedure.
距骨颈骨不连会导致严重的后足畸形和发病率，在文献中很少报道。这种情况的最佳手术治疗方法正在不断发展，许多作者报告了切开复位内固定（ORIF）加植骨（BG）、踝关节融合和改良 Blair 融合治疗距骨颈骨不连的结果。我们进行这项研究是为了报告通过踝关节保留重建治疗距骨颈骨不连的一组患者的临床和影像学结果。
这是一项前瞻性研究，共纳入 8 例距骨颈骨不连患者（7 例男性，1 例女性）。所有患者均通过双入路行 ORIF+BG。2 例患者行内踝骨切开术，3 例患者行距下关节跟腓骨切开术。5 例患者行辅助性距下关节融合术。术前和术后均进行临床和影像学评估。采用曼彻斯特-牛津足部问卷（MOxFQ）评估功能结果。
患者的平均年龄为 32.3±13.1 岁。平均手术延迟时间为 4.1±1.7 个月。根据 Zwipp 和 Rammelt 创伤后距骨畸形分类，5 例为 3 型，2 例为 4 型，1 例为 1 型。7 例患者平均在 3.4±1.3 个月后获得愈合。1 例患者出现进行性塌陷，行全距下关节融合术治疗。所有 3 例未行初次距下关节融合术的患者均出现距下关节炎，但均无需行二次距下关节融合术。术后 MOxFQ 评分从 61.1±10.1 分降至 41±14.1 分（P=0.005）。平均随访时间为 14.6±6.8 个月。
距骨颈 ORIF+BG 联合或不联合距下关节融合术有可能实现坚固愈合，纠正后足畸形，改善功能结果。然而，需要更大样本量和更长随访时间的研究来评估该手术的长期疗效。
