Case for small group discussion Talar malunion Case for small group discussion AOTrauma—Foot & Ankle Module 8: Hindfoot arthritis Stefan Rammelt and Hans Zwipp, DE

Case description 15-year-old girl Fell from a height Initial x-rays on the day of injury

Day of injury Stress x-ray 6 weeks later

Operative treatment after 6 weeks Percutaneous screw fixation from posterior

Another 3 months later

What would you do now?

Intraoperative findings

Postoperative images Preoperative Postoperative

1-year follow-up

17-month follow-up Preoperative Postoperative

Rammelt et al. Acta Orthop. 2005;76:588–596 Take-home messages Posterior screw fixation of the talus through a posterior approach does not allow assessment of anatomical reduction of the talar neck Secondary correction includes osteotomy and fusion of arthritic joints Preservation of joints with good cartilage cover Partial necrosis (without collapse) does not preclude reconstruction Reference: Rammelt S, Winkler J, Heineck J, Zwipp H. Secondary anatomical reconstruction for malunited talus fractures. A prospective study of 10 patients followed for 4 years. Acta Orthop. 2005 Aug;76(4):588–596. Rammelt et al. Acta Orthop. 2005;76:588–596