Chiang Jenny, Campbell Ryan J, Thomson Lauren, Wines Andrew, Sivakumar Brahman, Stewart David, Symes Michael J
From the Department of Orthopaedics, Hornsby Hospital.
Department of Orthopaedics and Trauma Surgery, Royal North Shore Hospital, Sydney.
Ann Plast Surg. 2025 Jul 1;95(1):59-62. doi: 10.1097/SAP.0000000000004367.
Management of talar neck fractures can be challenging due to the high rate of nonunion or malunion, avascular necrosis, and posttraumatic arthritis, which has been attributed to the disruption of the bone's tenuous blood supply during fracture displacement. Osseous medial femoral condyle (MFC) flaps are increasingly being used in the reconstruction of small bony defects due to recalcitrant nonunion and avascular necrosis in the upper and lower limbs. We report a rare case of an MFC flap used in the reconstruction of an acute talar neck fracture.A 38-year-old man presented with multiple injuries following a motor vehicle accident, including an open comminuted talar neck and lateral process fracture, with dislocation of the subtalar and talocrural joints (Hawkins III). Initial exploration and debridement demonstrated a significant defect in the dorsal portion of the talar neck. Temporary stabilization was achieved with Kirschner wires, and the defect was packed with bone cement. Two weeks later, an MFC flap was harvested from the ipsilateral knee and tailored to fit the talar defect. Fixation was achieved with cannulated compression screws. At 6 weeks postoperative, all wounds had healed, a radiograph demonstrated a positive Hawkins sign, and computed tomography showed incorporation of the flap. The patient had no donor site morbidity and commenced weight bearing at 3 months postoperatively. This is the first report demonstrating the viability of MFC flap reconstruction for the management of bony defects in acute talar neck fractures.
距骨颈骨折的治疗具有挑战性，因为其不愈合或畸形愈合、缺血性坏死以及创伤后关节炎的发生率很高，这归因于骨折移位过程中骨的脆弱血供遭到破坏。由于上肢和下肢顽固性不愈合及缺血性坏死，股骨内侧髁（MFC）骨瓣越来越多地用于小骨缺损的重建。我们报告了1例罕见的使用MFC骨瓣重建急性距骨颈骨折的病例。一名38岁男性在机动车事故后出现多处损伤，包括开放性粉碎性距骨颈和外侧突骨折，伴有距下关节和距小腿关节脱位（Hawkins III型）。初步探查和清创显示距骨颈背侧有明显缺损。用克氏针实现临时固定，缺损处用骨水泥填充。两周后，从同侧膝关节切取MFC骨瓣并进行修整以适应距骨缺损。用空心加压螺钉固定。术后6周时，所有伤口均愈合，X线片显示Hawkins征阳性，计算机断层扫描显示骨瓣已融合。患者供区无并发症，术后3个月开始负重。这是第一份证明MFC骨瓣重建用于治疗急性距骨颈骨折骨缺损可行性的报告。
