1
|
Presurgical Perspective and Postsurgical Evaluation of Calcaneal and Talus Fractures. Semin Musculoskelet Radiol 2022; 26:635-643. [PMID: 36791733 DOI: 10.1055/s-0042-1760119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Fractures of the calcaneus and talus are severe injuries that usually result from high-energy trauma. The calcaneus and talus are essential for the transmission of body weight, so an optimal reduction and/or fixation of fractures is required to prevent disabling consequences. These fractures almost always have an articular involvement, and an anatomical reduction is required; any residual step-off would lead to joint incongruity and secondary arthrosis.The aims of imaging are first, to guide management by describing the fracture characteristics (e.g., location, displacement, fragments, articular involvement, soft tissue compromise), and second, to detect early and late surgical complications (e.g., infection, malunion, nonunion, arthrosis, hardware issues). Although radiographs remain the first-line imaging modality for the screening of ankle and foot trauma, computed tomography is almost always required for the initial management and follow-up of the patient.
Collapse
|
2
|
Saravi B, Lang G, Ruff R, Schmal H, Südkamp N, Ülkümen S, Zwingmann J. Conservative and Surgical Treatment of Talar Fractures: A Systematic Review and Meta-Analysis on Clinical Outcomes and Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168274. [PMID: 34444022 PMCID: PMC8393919 DOI: 10.3390/ijerph18168274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022]
Abstract
The integrity of the talus is crucial for the physiologic function of the feet. The present study sought to summarize the available evidence on clinical outcomes and complications following conservative and surgical treatment of talar fractures. We systematically searched Medline via OVID to find relevant studies with a follow-up of at least six months. Hereafter, the success and complication rates were extracted and analyzed in a random effects proportion meta-analysis. Complications were defined as avascular bone necrosis (AVN) and posttraumatic osteoarthritis (OA). Additionally, a subgroup analysis was performed for fracture localization (talar neck fractures (TN) and combined talar body/neck fractures (TN/TB)) and severity of the fracture. The quality of the included studies was assessed utilizing the Coleman Methodology Score (CMS). A total of 29 retrospective studies, including 987 fractures with a mean follow-up of 49.9 months, were examined. Success rates were 62%, 60%, and 50% for pooled fractures, TN, and TN/TB, respectively. The overall complication rate for AVN was 25%. The rate was higher for TN (43%) than TN/TB (25%). Talar fractures revealed a 43% posttraumatic osteoarthritis (OA) rate in our meta-analysis. Success rates showed an association with fracture severity, and were generally low in complex multi-fragmentary fractures. The mean CMS was 34.3 (range: 19-47), indicating a moderate methodological quality of the studies. The present systematic review on clinical outcomes of patients undergoing conservative or surgical treatment for talar fractures reveals a lack of reliable prospective evidence. Talar fractures are associated with relatively poor postoperative outcomes, high rates of AVN, and posttraumatic osteoarthritis. Poor outcomes revealed a positive association with fracture severity. Prospective studies investigating predictors for treatment success and/or failure are urgently needed to improve the overall quality of life and function of patients undergoing surgical treatment due to talar fractures.
Collapse
Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
- Department of Spine Surgery, Loretto-Krankenhaus Freiburg, 79100 Freiburg, Germany
- Correspondence:
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
- Department of Spine Surgery, Loretto-Krankenhaus Freiburg, 79100 Freiburg, Germany
| | - Robert Ruff
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
| | - Norbert Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
| | - Sara Ülkümen
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
- Department of Spine Surgery, Loretto-Krankenhaus Freiburg, 79100 Freiburg, Germany
| | - Jörn Zwingmann
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany; (G.L.); (R.R.); (H.S.); (N.S.); (S.Ü.); (J.Z.)
- Department of Orthopedics and Trauma Surgery, St. Elisabeth Hospital Ravensburg, 88212 Ravensburg, Germany
| |
Collapse
|
3
|
Kitamura N, Yokota M, Nakagawa T, Yasuda K, Tsuchiya M. Talar head fracture in a professional baseball player: A case report. J Orthop Sci 2019; 24:1137-1143. [PMID: 28571923 DOI: 10.1016/j.jos.2017.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/25/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Nobuto Kitamura
- Department of Sports Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Masashi Yokota
- Department of Sports Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | - Teruhiko Nakagawa
- Department of Orthopaedic Surgery, Doai Memorial Hospital, Tokyo, Japan
| | - Kazunori Yasuda
- Department of Sports Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Japan
| | | |
Collapse
|
4
|
Biz C, Golin N, De Cicco M, Maschio N, Fantoni I, Frizziero A, Belluzzi E, Ruggieri P. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management. BMC Musculoskelet Disord 2019; 20:363. [PMID: 31391024 PMCID: PMC6686493 DOI: 10.1186/s12891-019-2738-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management. METHODS From January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed. RESULTS 27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49-119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7-7). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0-11 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9-10). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%). CONCLUSIONS Despite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF.
Collapse
Affiliation(s)
- Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Nicolò Golin
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Michele De Cicco
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Nicola Maschio
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| |
Collapse
|
5
|
Hood CR, Miller JR, Hollinger JK. Defining Talar Head and Neck Pathology: The Malvern Classification System. J Foot Ankle Surg 2018; 57:131-139. [PMID: 28843549 DOI: 10.1053/j.jfas.2017.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Indexed: 02/03/2023]
Abstract
Talar fractures account for <1% of all fractures in the body and 3% to 6% of pedal fractures. Of these fractures, avulsion and neck fractures represent the most and second most common type, respectively. Several classification systems exist for talar fractures of the talar dome (Berndt-Hardy), talar neck dislocation (Hawkins), and talar body (Sneppen) anatomic locations. Although diverse, they are not all encompassing for fracture patterns of the talus. Another set of pathologic issues occur about the talar head and neck region that can be seen in the clinical setting. Thus, a new classification system (Malvern classification system for talar head/neck fractures) was devised and defined for this location. The system represents a comprehensive review of the available published data and synthesis into an organized classification system.
Collapse
Affiliation(s)
- Christopher Robin Hood
- Fellowship-Trained Foot and Ankle Surgeon, Premier Orthopaedics and Sports Medicine, Malvern, PA.
| | - Jason Roy Miller
- Fellowship Director, Department of Foot and Ankle Surgery, Premier Orthopaedics and Sports Medicine, Malvern, PA; Residency Director, Podiatric Medicine and Surgery Residency/Reconstructive Rearfoot Ankle Surgery, Phoenixville Hospital, Phoenixville, PA
| | - Josuha Kevin Hollinger
- Fellow, Pennsylvania Intensive Lower Extremity Fellowship, Premier Orthopaedics and Sports Medicine, Malvern, PA
| |
Collapse
|
6
|
Buza JA, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg 2018; 24:282-290. [PMID: 29409210 DOI: 10.1016/j.fas.2017.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/09/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
Fractures of the talus are challenging to manage, with historically poor outcomes and a high rate of complications. The rare nature of this injury limits the number of studies available to guide treatment. Fortunately, a number of advancements have been made in the last decade. There is increased recognition regarding the importance of anatomic reconstruction of the osseous injury. Advanced imaging is used to assess the subtalar joint, where even slight displacement may predispose to arthritis. Increasing use of dual anteromedial and anterolateral approaches, along with plate fixation, has improved our ability to accurately restore the anatomy of the talus. Modification of the original Hawkins classification can both guide treatment and allow us to better predict which patients will develop avascular necrosis. Lastly, improved reconstructive techniques help address the most common complications after talus fracture, including arthritis, avascular necrosis, and malunion.
Collapse
Affiliation(s)
- John A Buza
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States
| | - Philipp Leucht
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States.
| |
Collapse
|