Clinical study of arthroscopic reduction and internal fixation for malunion and nonunion talus fractures classified as type II by Zwipp

Objective To investigate the surgical method of arthroscopic reduction and internal fixation (ARIF) for malunion and nonunion of type II talus fracture as per Zwipp classification, and to evaluate its therapeutic effect. Methods A retrospective analysis was performed on eight patients (five males and three females) with unilateral limbs treated with ARIF for malunion and nonunion of a talus fracture at our hospital between July 2014 and July 2022. The age ranged from 17 to 55 years, with an average of 34.9 ± 12.3 years. In all, five cases of talar body fracture and three cases of talar neck fracture were observed. The time interval between fracture and the present surgery was 8–16 months (average, 11.1 ± 2.5 months). According to the classification of malunion and nonunion of talus fracture by Zwipp, all the eight cases were classified as type II. Intraoperative autologous iliac bone grafting was performed for all patients. At the last follow-up, the ankle joint was assessed for range of motion and an X-ray examination was performed. Ankle joint function was evaluated as per the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results All eight patients were followed up for 10 to 52 months (average, 30.2 ± 14.2 months). All patients achieved primary wound healing, and 2 of them experienced Achilles tendon contracture, with no case of avascular necrosis of the talus, fracture nonunion, infection, or other complications. Ankle joint function was assessed according to the AOFAS score, with four cases assessed as “Excellent” and four as “Good” on the scale. Conclusion ARIF is a safe and effective surgical method for malunion and nonunion of type II talus fracture as per Zwipp classification with lesser secondary damage to the blood supply of the talus, fewer postoperative complications, and faster recovery. Level of Evidence Level II.