Review Question - QID 6730

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Talar Neck Fractures QID: 6730 (SAE09FA.42)

QID 6730 (Type "6730" in App Search)

A 23-year-old woman has had a 14-month history of ankle pain after surgical treatment of multiple injuries resulting from a motor vehicle accident. Weight bearing began 4 months after surgery. The pain occurs with weight bearing and motion, but there is very little pain at rest. She has no pertinent medical history and does not smoke. Figures 23a and 23b show current radiographs. What is the most appropriate surgical option?

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Talectomy

5/512

Revision open reduction and internal fixation (ORIF) with bone grafting

78%

397/512

Ankle arthrodesis

10/512

Tibiotalocalcaneal arthrodesis

28/512

Triple arthrodesis

12%

61/512

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The radiographs reveal nonunion of a talar neck fracture. There is no radiographic evidence of osteonecrosis or significant degenerative arthritis. The results of talectomy are suboptimal. Arthrodesis would be indicated for degenerative arthritis. Revision ORIF is feasible and preserves motion. A vascularized graft should be considered whenever osteonecrosis is present, but the talar body appears viable in this case.