Operative Orthopadie und Traumatologie, vol.8, no.4, pp.287-293, 1996 (SCI-Expanded)
Goal of Surgery Achievement of a functional, painless lower limb through elimination of a severe foot deformity. Improved dorsiflexion of the foot. Indications Severe and untreated clubfoot. Severe fracture-dislocation of talus (Hawkins III). Contraindications Circulatory insufficiencies. Osteoarthritis of ankle and subtalar joints. Positioning and Anaesthesia Supine, leg in external rotation and knee flexed. General or regional anaesthesia. Surgical Technique Removal of the talus through a medial approach after osteotomy of the medial malleolus. Anterior displacement of the foot and lateral displacement of the medial malleolus creating a joint between calcaneus and tibia and medial wall of calcaneus and medial malleolus. In instances of osteoporosis the osteotomy of the medial malleolus will be modified. Postoperative Management Below knee cast for 3 weeks. Followed by partial weight bearing in a cast. Full weight bearing without cast after 6 weeks. Possible Complications Incomplete removal of talus. Poor articular contact. Injury to nerves and vessels. Results 14 talectomies, mean follow-up 42 months. 8 patients had a standard procedure and were assessed according to the criteria of Morris: 6 excellent, 1 good and 1 poor result. 6 patients underwent a modified procedure (see Figure 6): 2 excellent and 4 good results. © Urban & Vogel.