1. 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

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

3. Day of injury
Stress x-ray
6 weeks later

4. Operative treatment after 6 weeks
Percutaneous screw fixation from posterior

5. Another 3 months later

6. What would you do now?

7. Intraoperative findings

8. Postoperative images
Preoperative
Postoperative

9. 1-year follow-up

10. 17-month follow-up
Preoperative
Postoperative

11. 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 Aug;76(4):588–596.
Rammelt et al. Acta Orthop. 2005;76:588–596