For talar malunions, any collapse of the articular surface should be elevated and bone graft is needed. Small bone grafts (<1cm) can be harvested from the distal tibial metaphysic, and large ones figure 2 (>1cm) should be taken from the iliac crest. For talar nonunions, both edges of the pseudarthrosis should be excised until alive bone tissue is reached. Any malalignment of the talus needs to be corrected using autogenous corticocancellous bone graft. Subchondral drilling or microfracture can prevent further progression of the talar necrosis. After having obtained a correct position, the reduction was maintained temporarily with 2.0-mm Kirschner wire, and then the definitive fixation could be achieved by cannulated screws. In most of our cases, we chose the cannulated screws.
Occasionally, a mini-plate was used for a stable fixation. The occurrence and development of arthritis depends on the extent of initial cartilage damage, the quality of the initial articular surface reduction and the time from the fracture to the second surgery. 15 – 17 MRI is a powerful tool in the preoperative assessment of arthritis and necrosis. But it is better to make a decision of the arthrodesis on the basis of the intraoperative observation, which provides direct visualization of the articular cartilage. Subtalar joint fusion is usually performed using two 6.5mm cannulated screws. When dealing with osteoporotic bone, or in bone defect reconstruction, full-threaded screws are recommended, since the “lagging” of partially threaded screws will result in shortening and foot arch collapse.
In addition, titanium hardwire should be selected so as to allow for MRI detection of talar AVN during the period of follow-up. Our patients received proper managements and gained satisfactory results. We evaluated the functional outcomes using the AOFAS ankle-hindfoot scale. The function of the hindfoot improved significantly. The mean postoperative AOFAS score was in accordance with other reports. 7 , 17 , 18 This could be attributed to the facts that most of our patients only had type I and type II deformities, for which an anatomic reconstruction was performed, and only six patients received limited arthrodesis. Besides, the operation was performed by senior surgeons and appropriate procedures were adopted, which also contributed to the favorable outcomes.
Moreover, the patients, who gained follow-up, were compliant and received reasonable postoperative management and rehabilitation. CONCLUSIONS Surgical interventions Entinostat for malunions and nonunions after talar fractures can bring about satisfactory outcomes. If the hindfoot joints are still healthy, every effort should be made to anatomically reconstruct the talus. Arthrodesis should be considered as a final salvage operation. The appropriate procedure should be adopted according to the different types of posttraumatic deformities. Footnotes Acta Ortop Bras. [online]. 2013;21(4):226-32.