Vascularized Medial Femoral Condyle Flap for the Management of an Acute Talar Neck Fracture

Management of talar neck fractures can be challenging due to the high rate of nonunion or malunion, avascular necrosis, and posttraumatic arthritis, which has been attributed to the disruption of the bone's tenuous blood supply during fracture displacement. Osseous medial femoral condyle (MFC) flaps are increasingly being used in the reconstruction of small bony defects due to recalcitrant nonunion and avascular necrosis in the upper and lower limbs. We report a rare case of an MFC flap used in the reconstruction of an acute talar neck fracture.A 38-year-old man presented with multiple injuries following a motor vehicle accident, including an open comminuted talar neck and lateral process fracture, with dislocation of the subtalar and talocrural joints (Hawkins III). Initial exploration and debridement demonstrated a significant defect in the dorsal portion of the talar neck. Temporary stabilization was achieved with Kirschner wires, and the defect was packed with bone cement. Two weeks later, an MFC flap was harvested from the ipsilateral knee and tailored to fit the talar defect. Fixation was achieved with cannulated compression screws. At 6 weeks postoperative, all wounds had healed, a radiograph demonstrated a positive Hawkins sign, and computed tomography showed incorporation of the flap. The patient had no donor site morbidity and commenced weight bearing at 3 months postoperatively. This is the first report demonstrating the viability of MFC flap reconstruction for the management of bony defects in acute talar neck fractures.