Article

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.

1 Follower
 · 
160 Views
  • Source
    • "221 37 Sirkin [47] 97 70 Mundermann [80] 65 4 Mann [14] 211 38 Williams [48] 96 71 Giannini [81] 65 5 Laaveg [15] 209 39 Nawoczenski [49] 94 72 Martin [82] 64 6 Kannus [16] 207 40 Mueller [50] 93 73 Paoloni [83] 63 7 Bostman [17] 189 41 Knecht [51] 92 74 Coughlin [84] 63 8 Funk [18] 167 42 Ogden [52] 92 75 Kofoed [85] 62 9 Cooper [19] 166 43 Stacoff [53] 92 76 Burnfield [86] 62 10 Bucholz [20] 157 44 Kumai [54] 92 77 Gobbi [87] 61 11 Lentell [21] 151 45 Armstrong [55] 92 78 Buechel [88] 61 12 Gerber [22] 144 46 Redmond [56] 90 79 Clare [89] 61 13 Coester [23] 143 47 Hodge [57] 90 80 Hunt [90] 61 14 Vail [24] 138 48 Shepherd [58] 88 81 Bibbo [91] 60 15 Rozzi [25] 134 49 Chiari [59] 86 82 Giannini [92] 59 16 Sangeorzan [26] 131 50 Tol [60] 86 83 Whittaker [93] 58 17 Wood [27] 129 51 Van Dijk [61] 86 84 Digiovanni [94] 58 18 Ponseti [28] 128 52 Khan [62] 85 85 Gautier [95] 57 19 Ekstrand [29] 128 53 Dobbs [63] 85 86 Bonnin [96] 53 20 Pyevich [30] 125 54 Spirt [64] 84 87 Thomas [97] 53 21 Bernier [31] 122 55 Acevedo [65] 82 88 Button [98] 52 22 Konradsen [32] 122 56 Hintermann [66] 80 89 Fuchs [99] 52 23 Teeny [33] 118 57 Beynnon [67] 80 90 Buechel [100] 51 24 Hopkinson [34] 118 58 Easley [68] 80 91 Pollak [101] 51 25 Mcilroy [35] 116 59 Ohberg [69] 79 92 Baums [102] 50 26 Pfeffer [36] 115 60 Haddad [70] 78 93 Nork [103] 49 27 Georgiadis [37] 113 61 Valderrabano [71] 76 94 Kay [104] 49 28 Anderson [38] 110 62 Coughlin [72] 75 95 Hertel [105] 48 29 Sanders [39] 109 63 Digiovanni [73] 74 96 Vallier [106] 47 30 Hangody [40] 108 64 Roos [74] 74 97 Dobbs [107] 46 31 Kitaoka [41] 108 65 Taranow [75] 72 98 Weening [108] 46 32 Riddle [42] 104 66 Minami [76] 69 99 Bus [109] 46 33 Hoffman [43] 102 67 Ippolito [77] 67 100 Henricson [110] 45 34 Papa [44] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The number of citations of a paper gives an indication of an article's merit and importance within a medical specialty. We identify and analyse the 100 most cited papers in foot and ankle surgery. Method The Science Citation Index Expanded was searched for citations in 15 respected journals containing foot and ankle articles. Papers were analysed for subject, authorship, institution, country and year of publication. The average yearly citation was compared to total number of citations. Results 3,501 foot and ankle papers were returned. The maximum number of citations was 1084 and the mean was 104. The top 100 papers were published between 1979 and 2007, with the majority published in the last decade. The ankle was the most important anatomical region discussed, and basic science and degenerative disease were popular topics. We found a large discrepancy between the total number of citations with average yearly citation. Conclusion Foot and ankle surgery is a young and rapidly developing sub-specialty within orthopaedics. Recently there has been a significant increase in influential papers published. Certain topics are popular indicating their importance within the field. This study highlights important papers in foot and ankle surgery giving an insight into readership.
    The Foot 01/2013; 24(1). DOI:10.1016/j.foot.2013.11.003
  • Source
    • "It remains to be demonstrated that osteonecrotic collapse can also be prevented after fractures. There is still a risk of collapse in undisplaced and nailed femoral neck fractures (Damany et al. 2005), and for dislocated fractures of the talar neck the risk is very high (Vallier et al. 2004). "
    Acta Orthopaedica 05/2006; 77(2):175-6. DOI:10.1080/17453670610045894 · 2.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    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.
Show more

Preview

Download
8 Downloads
Available from

Similar Publications