Article

Open reduction and stable fixation of isolated, displaced talar neck and body fractures

Orthopaedic Trauma Service, Florida Orthopaedic Institute, 4 Columbia Drive, Suite 710, Tampa, FL 33606, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 4.31). 11/2004; 86-A(10):2229-34.
Source: PubMed

ABSTRACT The purpose of this retrospective review was to evaluate the long-term results of surgical treatment of isolated, displaced talar neck and/or body fractures with stable internal fixation.
The study included twenty-five patients with a total of twenty-six displaced fractures isolated to the talus that had been treated with open reduction and stable internal fixation and followed for a minimum of forty-eight months after the injury. The final follow-up examination included standard radiographs, computed tomography, and a clinical evaluation. Variables that were analyzed included wound type, fracture type, Hawkins type, comminution, timing of the surgical intervention, surgical approach, quality of fracture reduction, Hawkins sign, osteonecrosis, union, time to union, posttraumatic arthritis, and the AOFAS scores including subscores (pain, function, and alignment).
The average duration of follow-up was seventy-four months. Surgical intervention resulted in sixteen fractures with an anatomic reduction, five with a nearly anatomic reduction, and five with a poor reduction. All eight noncomminuted fractures were anatomically reduced. The overall union rate was 88%. All closed, displaced talar neck fractures healed, regardless of the time delay until surgical intervention. Posttraumatic arthritis of the subtalar joint was the most common finding and was seen in all patients, sixteen of whom had involvement of more than one joint. Osteonecrosis was a common finding, seen after thirteen of the twenty-six fractures overall and after six of the seven open fractures.
Open reduction and internal fixation is recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Patients with a displaced fracture of the talus should be counseled that posttraumatic arthritis and chronic pain are expected outcomes even after anatomic reduction and stable fixation. This is especially true following open fractures.

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    • "Worse outcomes were noted in association with comminuted fractures, associated talar neck fractures and open fractures [4]. Lindvall et al., in 2004, reported on 26 isolated cases of talar neck and body fractures with a minimum follow-up of 48 months and found a 50% incidence of AVN and 100% incidence of post-traumatic arthritis. Timing of fixation did not seem to affect the outcome, union or prevalence of AVN in the later study [10]. "
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    ABSTRACT: Fractures of talar body are rare and serious injuries and frequently seen in multiply injured and polytraumatised patients. The high variability of talar fractures, their relatively low incidence together with the high percentage of concomitant injuries makes treatment of these injuries a challenge to the surgeon. We treated three patients with talus body fracture and multiple articular fractures of the distal tibia. The patients were male, aged 36, 34 and 40 years. All cases were treated by open reduction and internal fixation. All the fractures were united during an average follow-up of 13 months and there were neither non-union nor collapses due to avascular necrosis.
    Cases Journal 06/2009; 2(1):7953. DOI:10.4076/1757-1626-2-7953
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    • "Worse outcomes were noted in association with comminuted fractures, associated talar neck fractures and open fractures [20]. Lindvall et al., in 2004, reported on 26 isolated talar neck and body fractures with a minimum follow-up of 48 months and found a 50% incidence of AVN and 100% incidence of post-traumatic arthritis. Timing of fixation did not appear to affect the outcome, union or prevalence of AVN in the later study because the fractures that were stabilised within 6 h did not have a lower incidence of AVN than those stabilised after 6 h [13]. "
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    ABSTRACT: Fractures of the talar body present a great challenge to surgeons due to their rarity and high incidence of sequelae. This study reports the medium-term results of displaced fractures of the talar body treated by internal fixation. Nineteen patients (13 M, 6 F, mean age 31) with talar body fractures were studied retrospectively to assess outcome after operative treatment. The fractures were classified as coronal (11), sagittal (6) and crush fractures (2). Six patients sustained open fractures and two had associated talar neck fractures. Average follow-up was 26 months (range: 18-43). Clinical outcome based on American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring was excellent function in four patients, good in six, fair in four and poor in five. Early complications included two superficial wound infections, one partial wound dehiscence, one instance of skin necrosis and one deep infection. Other complications included delayed union in one, avascular necrosis in seven and malunion in one patient. Talar injuries are serious because they can compromise motion of the foot and ankle and result in severe disability. Crush fractures of the talar body and those associated with open injuries and talar neck fractures are associated with a less favourable outcome.
    International Orthopaedics 07/2007; 32(6):773-7. DOI:10.1007/s00264-007-0399-5 · 2.02 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to compare the mechanical stability of cannulated conical variable pitch headless (CH) screws to partially threaded 4.0 cannulated (4.0 C) screws for fixation of talar neck fractures. Methods: A controlled talar neck fracture was produced in 24 sawbone tali. The fractures were stabilized with CH screws in 12 tali and with 4.0 C screws in 12 tali. A Mechanical Testing System machine was used to apply a dorsally-directed shear force to the talar head with the talus body fixed to simulate walking and the clinical mode of failure of talar neck fracture fixation. Stiffness of the fixation devices was calculated for each specimen and the groups statistically compared. The results were confirmed in 10 cadaveric bone specimen. Results: The fixation of talar neck fractures by the CH screws was significantly stiffer than the 4-0 C screw (mean 635 N and 335 N, respectively, P < 0.05). Conclusions: The results of this study support the clinical use of the cannulated conical headless variable pitch screw for talar neck fracture fixation. The improved fixation of this device is likely to decrease the incidence of fixation failure and poor clinical results due to malunion, nonunion,and stiffness. The CH can be placed using the same surgical exposure and ease of a 4.0 C screw,while eliminating the problem of screw head prominence.
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