Talar neck fractures: results and outcomes.

Harborview Medical Center, Seattle, WA 98104, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 4.31). 09/2004; 86-A(8):1616-24.
Source: PubMed

ABSTRACT Talar neck fractures occur infrequently and have been associated with high complication rates. The purposes of the present study were to evaluate the rates of early and late complications after operative treatment of talar neck fractures, to ascertain the effect of surgical delay on the development of osteonecrosis, and to determine the functional outcomes after operative treatment of such fractures.
We retrospectively reviewed the records of 100 patients with 102 fractures of the talar neck who had been managed at a level-1 trauma center. All fractures had been treated with open reduction and internal fixation. Sixty fractures were evaluated at an average of thirty-six months (range, twelve to seventy-four months) after surgery. Complications and secondary procedures were reviewed, and radiographic evidence of osteonecrosis and posttraumatic arthritis was evaluated. The Foot Function Index and Musculoskeletal Function Assessment questionnaires were administered.
Radiographic evidence of osteonecrosis was seen in nineteen (49%) of the thirty-nine patients with complete radiographic data. However, seven (37%) of these nineteen patients demonstrated revascularization of the talar dome without collapse. Overall, osteonecrosis with collapse of the dome occurred in twelve (31%) of thirty-nine patients. Osteonecrosis was seen in association with nine (39%) of twenty-three Hawkins group-II fractures and nine (64%) of fourteen Hawkins group-III fractures. The mean time to fixation was 3.4 days for patients who had development of osteonecrosis, compared with 5.0 days for patients who did not have development of osteonecrosis. With the numbers available, no correlation could be identified between surgical delay and the development of osteonecrosis. Osteonecrosis was associated with comminution of the talar neck (p < 0.03) and open fracture (p < 0.05). Twenty-one (54%) of thirty-nine patients had development of posttraumatic arthritis, which was more common after comminuted fractures (p < 0.07) and open fractures (p = 0.09). Patients with comminuted fractures also had worse functional outcome scores.
Fractures of the talar neck are associated with high rates of morbidity and complications. Although the numbers in the present series were small, no correlation was found between the timing of fixation and the development of osteonecrosis. Osteonecrosis was associated with talar neck comminution and open fractures, confirming that higher-energy injuries are associated with more complications and a worse prognosis. This finding was strengthened by the poor Foot Function Index and Musculoskeletal Function Assessment scores in these patients. We recommend urgent reduction of dislocations and treatment of open injuries. Proceeding with definitive rigid internal fixation of talar neck fractures after soft-tissue swelling has subsided may minimize soft-tissue complications.

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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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