Outcome of Type 3 Talar Neck Fractures by Means of Medial Malleolar Osteotomy and Large Distractor / 대한정형외과학회잡지

PURPOSE: The clinical and radiological results of patients with type 3 talar neck fractures treated with the anteromedial approach using medial malleolar osteotomy and large distractor were analyzed retrospectively. MATERIALS AND METHODS: From March 2009 to August 2016, 12 patients with a type 3 talar neck fracture, who underwent the anteromedial approach using a medial malleolar osteotomy and large distractor and who could be followed-up for more than 12 months after the operation, were examined. The patients were examined for the presence of Hawkins signs by anteroposterior and lateral radiographs and osteonecrosis by magnetic resonance imaging (MRI) on the postoperative 3 months. Subsequently, every 3 months, radiographic union was assessed by a simple radiograph and clinical symptoms. Twelve months postoperatively, posttraumatic arthritis was assessed and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was analyzed. RESULTS: In 7 cases, osteonecrosis was found on MRI performed 3 months after surgery. On the other hand, at the 12 months follow-up, all of them obtained AOFAS scores of 83.86±4.53 without surgical treatment. Radiographic union was achieved in all cases. The mean union period was 5.3 months. In 10 cases, traumatic arthritis was found after the radiographical and clinical evaluation. In addition, all of them could carry on everyday life by conservative treatment. The AOFAS ankle-hindfoot score was measured to be 85.17 on average. Other complications included superficial wound infection in 2 cases. CONCLUSION: An anteromedial approach using a medial malleolar osteotomy and a large distractor in the surgical treatment of patients with type 3 talar neck fractures can achieve anatomical reduction of the displaced fragment without a lateral dissection. This is considered to be another good surgical option.

Results of Autologous Osteochondral Transplantation of the Ostochondral Lesion on the Talus: A Comparison Study between Medial Malleolar Osteotomy Approach and Anterior Arthrotomy Approach / 대한족부족관절학회지

PURPOSE: Osteochondral lesion of the talus (OLT) has traditionally been treated using an autologous osteochondral graft via the medial malleolar approach. Here, we compare the traditional method with the anterior arthrotomy approach. MATERIALS AND METHODS: Between January 2005 and June 2015, 24 cases of patients who received autologus osteochondral graft for OLT and with at least 2 years of follow-up were evaluated. They were divided into two groups; one group receiving autologous osteochondral graft via the medial malleolar osteotomy approach (group 1, n=9) and another group via the anterior arthrotomy approach (group 2, n=15). The clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: In all cases, the size of the subchondral cyst of the talus decreased, if not disappeared on the final follow-up radiograph. All osteochondral grafts were united. The mean AOFAS score increased from 61.5 preoperatively to 84.9 at the final follow-up. The mean AOFAS score of group 1 increased from 60.3 preoperatively to 78.0 (p=0.007) at the final follow-up, and the mean AOFAS score of group 2 also increased from 62.2 to 89.1 (p=0.006). The AOFAS score was statistically better in group 2 than in group 1 (p=0.034) at the final follow-up. CONCLUSION: Autologous osteochondral graft of the OLT yields satisfactory radiologic and clinical outcomes. Especially, better clinical outcome was observed in the group using the anterior arthrotomy approach (group 2) than in the group using the medial malleolar osteotomy approach (group 1).

Results of Operative Treatment for Large Osteochondral Lesion of Medial Talar Dome / 대한족부족관절학회지

PURPOSE: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. MATERIALS AND METHODS: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. RESULTS: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. CONCLUSION: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.