No postoperative complications such as wound healing problems or infections occurred. Solid union was obtained without redislocation in all patients. No development or progression of AVN was observed in any patients. The mean selleck inhibitor time to achieve bone union was 14 weeks (range, 12 to 18). The mean time to complete weight-bearing was 16 weeks (range, 14 to 20). The mean AOFAS score increased from 36.2 (range, from 27 to 43) to 85.8 (range, from 74 to 98). All patients stated that they were satisfied with the results. Table 2 Statistical description of talar deformities classification, surgical treatment, and outcomes. DISCUSSION The talus takes part in the composition of the ankle, subtalar and talonavicular joints and plays a pivotal role in overall foot function.

Because two thirds of the talar surface is covered with articular cartilage, and the blood supply to the talus is vulnerable to injury, once talar fractures happen, neglected or mal-reduced talar fractures may produce talar malunions or nonunions. The common complications associated with talar fractures include skin necrosis, osteomyelitis, AVN of the talus, malunion, nonunion, and post-traumatic arthritis. Among these complications, malunion may be more common. 2 , 7 Malunited talar fractures would lead to shortening and deformity of the medial column, thus leading to disability of the foot function. Talar nonunions would lead to articular incongruity and malposition of the related joints, thus leading to osteoarthritis and long-term pain. Deformity correction and anatomic reconstruction are essential to restore the normal foot function and prevent other complications.

There are few classification systems of malunions or nonunions after talar fractures. In 2003, Zwipp and Rammelt 11 reported a classification of posttraumatic talar deformities. According to their suggestions, and in consideration of our experiences, we draw the conclusions for treating talar malunions and nonunions as follows: For type I to III deformities, delayed talar anatomic reconstruction with preservation of the joints can be attempted in young, compliant and active patients who have sufficient bone stock. Patients who have type I to III deformities in combination with severe, symptomatic posttraumatic arthritis or who have systemic diseases can be treated with deformities realignment in combination with subtalar or ankle joint fusion.

Patients who have type IV deformities can be treated with excision of necrotic bone and tibiotalocalcaneal fusion with autologous bone grafting. For type V deformities, a repeated debridement Dacomitinib of infected and necrotic bone is needed and a subtotal talectomy is almost inevitable. In our cohort, nine patients (type I) received anatomic reconstruction, five patients (three type II and two type III) received anatomic reconstruction combined with bone grafting, and six patients (four type II and two type III) received deformities realignment combined with subtalar fusion.