Severe Talar Neck Fractures . Analysis of Treatment in 20 Cases (original) (raw)
Introduction: Talar neck fractures are rare but present a high rate of complications and reoperations. The objective of this work was to analyze and describe the complications in the medium and long term in 20 patients with talar neck fracture. Our hypothesis was that, in severe injuries, ORIF presents a high rate of complications that will require new surgical interventions. Materials and Methods: We evaluated 20 patients with talar neck fracture: 6 Hawkins II (29%), 11 Hawkins III (52%), and 3 Hawkins IV (19%). The mean follow-up was 11 years. We analyzed the fracture pattern (simple or comminuted), the presence of associated injuries, complications, and the need to perform a new surgical procedure. results: 11 (55%) had associated injuries and 14 (70%) had comminution in the fracture line. We presented complications in 15 patients (75%). 9 (45%) patients required a second intervention to treat the complication. Discussion: The factors most related to the development of complicati...
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Talar Neck Fractures: Results and Outcomes
The Journal of Bone and Joint Surgery-American Volume, 2004
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Talar Neck Fractures: An Overview
Talar injuries are infrequently encountered in practice as the majority require a high energy force such as road traffic accident or fall from height and they are often presented as complex injuries. Talar neck fracture accounts for half of these injuries. Because of the high rate of avascular necrosis (AVN) and posttraumatic arthritis associated with these injuries, it is difficult to predict the prognosis of AVN with the current classification systems. The anatomical position, difficulty of surgical approaches and its complex blood supply add to the challenges. Early recognition and a robust management plan are essential in treating such injuries. Failure to recognize a displaced talus fracture can result in Osteonecrosis, osteoarthritis, malunion or non-union which affects the hind foot function and results in pain, loss of motion and deformity. The integrity of this bone is vital for the function of the ankle, subtalar and mid tarsal joints. This article is an overview of this challenging injury including the mechanism of injury, classification, management and rehabilitation.
Fourteen years follow up of an unclassified Talar body fracture with review of literature
Foot and Ankle Surgery, 2006
Talar body fractures are rare. Four major types of talar neck fractures are known but talar body fractures are rarely described. An unusual case of a sagittal fracture of the body of talus is reported in this article. No similar cases are reported in the English literature to the best of our knowledge. The risk of avascular necrosis is very high and accurate reduction with solid fixation remains the key to better outcome. We discuss the possible mechanism of injury along with review of literature.
Talar fractures are difficult and rare injuries with incidence of less than 2% 1 , are one of the most challenging and devastating injuries with varied prognosis, posing a real time challenge to orthopedic surgeons. METHODS: The study is a prospective multicenter randomized therapeutic study initiated in December '2006 on 40 patients with talus fracture to highlight and compare the different modalities of management of talar fractures in terms of functional and clinical results and complications. RESULTS: Out of 40 patients, 32 were male and 8 were female with a male/female ratio of 4:1. Most fractures were due to RTA in 22 cases. Most fractures were in neck of talus in 20 (50%). Out of 40 talar fractures, 10 were managed conservatively, 18 operated with screw fixation, 4 were fixed with cross K-wires and 8 old cases were managed with Blair's fusion. We experienced complications in 12 cases. DISCUSSION: A high degree of suspicion is required for the diagnosis of talus/ talar processes fractures, talus being the second most common tarsal bone to fracture. The preferred surgical timing for talar neck fractures is controversial. But the scenario in the sub-continent is quite different wherein the patients report late to the hospital often due to ignorance, quack therapy and illiteracy, often presenting with complicated and neglected injuries. Also, published literature and long term prospective studies on talar fractures, its treatment and complications based on our population is lacking.
Management of 6 Months old Neglected Talus Neck Fracture: A Case Report with Review of Literature
Asian Journal of Medical Research
Talus fractures are very rarely seen and account for approximately 1 percent of fractures around the foot and ankle Talar neck fractures are likely to damage the anastomotic ring, resulting in disruption of blood supply to the talar body which leads to significant problems in fracture healing and integrity. Approximately 39 percent of midfoot and ankle fractures could be missed during initial evaluation due to a lack of adequate radiological and clinical examination. Among these missed injuries approximately 50 percent are talus fractures. A 23-year-old male patient came with complaints of pain over the left foot while walking for 6 months. He had a history of falls from 10 feet height 6 months back. He was conservatively managed in a local hospital without any proper diagnosis. He presented to us 6 months later with chronic, dull aching, continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and wa...
Talar Neck Fracture after Tibiotalar Arthrodesis: Case Report
Foot & Ankle International, 2011
Fractures of the talar neck are uncommon and typically follow high energy trauma. Displaced fractures associated with peritalar dislocations have been shown to have poor outcomes with high complication rates. 1-13 We report an unusual case of a patient who underwent successful ankle arthrodesis who then sustained a low energy trauma resulting in a displaced talar neck fracture. She went on to have open reduction internal fixation with subsequent healing. To our knowledge there has been no previous report of this in the literature. Although likely a rare occurrence we feel that this association may be underreported. We use this case to highlight issues regarding surgical technique when performing ankle arthrodesis and how screw placement may predispose patients to talar neck fractures. In addition we discuss considerations & techniques for internal fixation of a talar neck fracture after ankle arthrodesis. Finally we discuss how this case report may highlight current thoughts regarding the pathomechanics of talar neck fractures.
Arthroscopically assisted fixation of Hawkins type II talar neck fractures
The bone & joint journal, 2018
Aims Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures.
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