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Malunion of the Talus
Malunion of the talus has multiple causes. It results most frequently from inadequate fracture reduction or fixation. Nonsurgical management of a displaced talar neck fracture will lead to malunion or nonunion. With surgery, nonunion of the talar neck or body (perhaps because of inadequate fixation) is seen in fewer than 10% of patients in most surgical series; however, malunion may be more prevalent. Biomechanical investigations have shown that malalignment of as little as 2 mm at the talar neck results in significant load redistribution between the posterior, medial, and anterior facets of the subtalar joint, which potentially leads to the development of posttraumatic arthritis. This chapter reviews surgical steps for treating talar malunions, including anatomic correction of malunited fractures of the talar head, neck, and body, as well as arthrodesis of the affected joints.