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Hamilton GA, Doyle MD, Ligas CJ. Management of Talus Fractures. Clin Podiatr Med Surg 2024; 41:451-471. [PMID: 38789164 DOI: 10.1016/j.cpm.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Fractures of the talus are life-changing events. The talus is of vital importance to normal gait. Given its importance, great care is needed in diagnosing and treating these injuries. The threshold for operative treatment and accurate anatomic reduction should be low. Surgical tenets include the avoidance of extensive subperiosteal dissection to minimize vascular disruption. The complications with injuries to the talus are extensive and include avascular necrosis (AVN). Although AVN can prove to be a devastating sequela from this injury, it occurs less frequently than posttraumatic arthritis.
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Affiliation(s)
- Graham A Hamilton
- The University of Texas Health Science Center, San Antonio. Department of Orthopedics and Podiatry, 7703 Floyd Curl Drive, MC 7776, San Antonio, TX 78229-3900, USA.
| | - Matthew D Doyle
- Department of Orthopedics and Podiatry, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA
| | - Chandler J Ligas
- Department of Podiatry, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 E EL Camino Real, Mountain View, CA 94040, USA
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Lee JY, Ryu JH, Kook JM, Oh JS. Midterm Outcomes after Operative Management of Hawkins Type III Talar Neck Fractures. Clin Orthop Surg 2024; 16:470-476. [PMID: 38827753 PMCID: PMC11130635 DOI: 10.4055/cios23391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 06/04/2024] Open
Abstract
Background This study aims to report the midterm outcomes after surgical treatment of Hawkins Classification III Talar neck fractures. Methods From March 2010 to April 2022, among a total of 155 patients who visited our hospital with talus fractures, 31 patients underwent surgical treatment for Hawkins classification III talar neck fractures. The inclusion criteria comprised patients with a symptom duration of over 1 year who were available for outpatient follow-up and underwent magnetic resonance imaging (MRI) follow-up 2 months after surgery. Exclusion criteria included patients without preoperative ankle periarticular arthritis, and a total of 27 patients were enrolled. Traffic accidents and falls accounted for 86% of 23 cases, open fractures were 8 cases, and the mean follow-up period was 34.10 months (range, 12-80 months). Clinical outcomes were measured by American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot function index (FFI), and radiological results were obtained using simple radiographs before and after surgery and MRI at 2 months postoperatively to confirm bone union and complications. Results Complete bone union was achieved in all cases, and the mean duration of union was 4.9 months (range, 4-6 months) and there were no nonunion and varus malunion. At the final follow-up, the mean AOFAS score was 80.18 points (range, 36-90 points) and the mean FFI score was 31.43 points (range, 10-68 points), showing relatively good clinical outcomes. There were 15 cases of avascular necrosis, 6 cases of traumatic arthritis of the ankle joint, 6 cases of irritation of the posterior tibial nerve, and 4 cases of wound problems. Conclusions Hawkins classification III talar neck fractures are mostly caused by high-energy injuries and have a relatively poor prognosis due to the high incidence of complications such as avascular necrosis or posttraumatic arthritis. However, if correct anatomical reduction and rigid internal fixation are performed within a short time after the injury, good results can be expected.
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Affiliation(s)
- Jun-Young Lee
- Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Je-Hong Ryu
- Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Jung-Min Kook
- Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Jeong-Soo Oh
- Department of Orthopaedic Surgery, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
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Pradhan A, Najefi A, Patel A, Vris A, Heidari N, Malagelada F, Parker L, Jeyaseelan L. Complications after talus fractures: A trauma centre experience. Injury 2023; 54:772-777. [PMID: 36543737 DOI: 10.1016/j.injury.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Talus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. METHODS We retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. RESULTS The mean age was 35 years (range: 18-76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. CONCLUSION Our study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated.
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Affiliation(s)
- Akhilesh Pradhan
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR.
| | - Ali Najefi
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Amit Patel
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Alexandros Vris
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Nima Heidari
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Francesc Malagelada
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Lee Parker
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
| | - Lucky Jeyaseelan
- Foot and Ankle Unit, Bone & Joint Health, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR
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Selim A, Naqvi AZ, Magill H, Smith J. Fracture neck of the talus with isolated talonavicular dislocation: A case report. Medicine (Baltimore) 2022; 101:e28073. [PMID: 36343062 PMCID: PMC9646572 DOI: 10.1097/md.0000000000028073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Talar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification. PATIENT CONCERNS A 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight. DIAGNOSIS Talar neck fracture with an unusual isolated talonavicular dislocation. INTERVENTIONS Temporary closed reduction followed by open reduction and internal fixation were performed. OUTCOMES The patient had excellent functional and radiological outcomes following surgical management. CONCLUSION We discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.
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Affiliation(s)
- Amr Selim
- Cairo University Hospitals, Cairo, Egypt
- Homerton Hospital, London, UK
- *Correspondence: Amr Selim, Homerton Hospital, London, United Kingdom, E9 6SR (e-mail: )
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Linder A, Steiger V, Hubert L, Rony L. Clinical and radiological outcomes of internal fixation of complex talar neck and body fractures with locking plates through a dual approach. Orthop Traumatol Surg Res 2022; 108:103368. [PMID: 35850424 DOI: 10.1016/j.otsr.2022.103368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Talar fractures are rare and surgical treatment has not been standardized. The literature is rather poor on preserving talar vascularization in single or dual approaches. A dual approach allows better exposure and should limit devascularization. Locking plates are one of the modern solutions for challenging comminuted fractures. The aim of this study was to determine clinical and radiological outcomes in complex talar fracture (CTF) of the neck and body, fixed by locking plates through a dual approach with at least one locking plate. HYPOTHESIS Locking-plate fixation of CTF through a dual approach leads to good clinical outcome. MATERIAL AND METHODS A single-center retrospective study included 12 cases of CTF treated between January 2007 and May 2019. 3D CT was systematically performed to plan surgery. A dual approach and at least one locking plate were used for fixation. Clinical outcome was evaluated on AOFAS score. Reduction quality and correlation to clinical results were evaluated, reduction with<2mm joint step being considered satisfactory. Consolidation rate and occurrence of avascular necrosis of the talus (ANT), post-traumatic arthritis (PTA) and postoperative complications were analyzed. RESULTS Mean follow-up was 27 months (range, 15-47). Mean AOFAS score was 70±18 (range, 30-97). Inframillimetric reduction was achieved in 67% of cases, without significant correlation with clinical results. The consolidation rate was 91.6%, ANT rate 18.2% and PTA rate 45.5%. One patient presented septic osteoarthritis secondary to scar necrosis. CONCLUSION Locking plate fixation of CTF through a dual approach provided acceptable clinical outcomes. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Adrien Linder
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Vincent Steiger
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Laurent Hubert
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Louis Rony
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France.
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Talar Body Fracture Treated by Hindfoot Endoscopic Reduction and Internal Fixation. Case Rep Orthop 2022; 2022:6183508. [PMID: 35615458 PMCID: PMC9126715 DOI: 10.1155/2022/6183508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background A talar body fracture is relatively rare. Surgical treatment for the fracture is generally indicated for the displaced fracture types and traditionally performed via open approaches. However, open approaches may not be able to achieve adequate exposure of the talus body owing to the difficulty in achieving reduction and fixation of the fracture. In this case report, we describe a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. Case report. A 39-year-old man who was a carpenter complained of right hindfoot pain after he fell from a stepladder during work. Although plain radiographs of the right ankle showed no abnormal findings, noncontrast computed tomography demonstrated a fracture line from the lateral side of the posterior lateral process to the medial side of the talus body. In addition, the fracture line extended to the posterior ankle and subtalar joints, and the bone fragment was slightly displaced. We diagnosed him with the talar body fracture and performed operative treatments using hindfoot endoscopic reduction and internal fixation. At 14 weeks after the operation, he was able to return to work at the preinjury activity level without dysfunction of the ankle nor complications. Conclusion We reported a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. In this case, the hindfoot endoscopic technique provided visualization of the fracture site with less invasiveness and increased safety, which enabled proper reduction and internal fixation of the fracture site. Therefore, the patient was able to return to work at the preinjury activity level at 14 weeks after surgery without dysfunction of the ankle nor complications. This surgical technique may be a useful option for the talar body fracture.
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vonGaza GL, Chiu LZF. Comparison of Alternative Methods to Improve Weight-Bearing Sagittal Plane Anterior Leg Rotation. J Strength Cond Res 2021; 35:3315-3321. [PMID: 35133995 DOI: 10.1519/jsc.0000000000004150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT vonGaza, GL, and Chiu, LZF. Comparison of alternative methods to improve weight-bearing sagittal plane anterior leg rotation. J Strength Cond Res 35(12): 3315-3321, 2021-Promoting rearfoot plantar flexion may permit greater sagittal plane anterior leg rotation in weight-bearing tasks. Anterior leg rotation, where the proximal tibia translates forward, is required for tasks such as squatting and landing from a jump. Twenty-eight individuals with less than 25° anterior leg rotation during a weight-bearing lunge test were enrolled and randomly assigned to self-massage and stretching only (n = 15; 14 subjects retained) or self-massage and stretching plus gastrocnemius exercise (n = 13). Anterior leg rotation was assessed during a weight-bearing lunge test and a partial squat; 95% confidence interval (95% CI) of the change score and Cohen's d effect size were calculated. Anterior leg rotation in the weight-bearing lunge increased in the self-massage and stretching only (left: 95% CI [2.1°-5.4°], d = 1.14; right: 95% CI [2.3°-6.0°], d = 1.22) and self-massage and stretching plus gastrocnemius exercise (left: 95% CI [2.3°-7.5°], d = 1.71; right: 95% CI [4.2°-8.6°], d = 1.48) groups. There were no changes in anterior leg rotation in the partial squat for self-massage and stretching only (left: 95% CI [-1.2° to 2.5°], d = 0.15; right: 95% CI [-0.5° to 2.6°], d = 0.24) or self-massage and stretching plus gastrocnemius exercise (left: 95% CI [-0.2° to 4.8°], d = 0.55; right: 95% CI [-0.2° to 4.0°], d = 0.59) groups. Increases in anterior leg rotation in the weight-bearing lunge may be due to decreased passive stiffness in the plantar structures.
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Affiliation(s)
- Gabriella L vonGaza
- Neuromusculoskeletal Mechanics Research Program, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Chronic Fracture of the Posteromedial Tubercle of the Talus Masquerading as Os Trigonum Syndrome. Case Rep Orthop 2021; 2021:6637081. [PMID: 34258093 PMCID: PMC8261161 DOI: 10.1155/2021/6637081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Posterior ankle impingement syndrome (PAIS) can be caused by osseous pathology from the posterior aspect of the talus. The commonest cause is an os trigonum, an accessory ossicle arising from the lateral tubercle of the posterior talus. We have observed cases where the osseous impingement is due to a chronic fracture nonunion of the medial tubercle of the posterior talus with unique symptoms, differentiating this clinical syndrome from the more common os trigonum syndrome. These can be readily overlooked on imaging and confused with an often coexisting os trigonum. Awareness of these lesions is paramount to ensure appropriate management and safe surgery. We describe a series of patients presenting to the senior author with this clinical syndrome, discuss its unique clinical and radiological features, and describe our surgical technique.
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Abstract
BACKGROUND Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. METHODS This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. RESULTS All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. CONCLUSION Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Olivier Wijers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Jelle Posthuma
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
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Sanders D. Acute Arthrodesis of Ipsilateral Pilon and Talus Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00026. [PMID: 33979809 DOI: 10.2106/jbjs.cc.20.00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a unique case of an ipsilateral distal tibia pilon fracture and talar body after motor vehicle collision. Our patient was successfully treated with acute arthrodesis of the tibiotalar joint, with return to good function 1-year after surgery. CONCLUSION Pilon and talus fractures are complex injuries. They require specialized surgical care, are complicated by loss of function, continued pain, and lead to subsequent reconstructive procedures such as arthrodesis or arthroplasty. In the presence of concomitant pilon and talus fractures, acute arthrodesis can yield good results and return to function.
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Affiliation(s)
- Drew Sanders
- University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas
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The role of external fixation in the management of infected avascular necrosis after traumatic talus fractures. Foot (Edinb) 2020; 44:101644. [PMID: 32593134 DOI: 10.1016/j.foot.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Avascular necrosis (AVN) after fractures of the talus is a distinct and challenging clinical entity that is associated with poor outcomes. Although several articles are published on the management of posttraumatic AVN of the talus, very little is known about the management of infected AVN after talus fractures. Therefore, three cases of infected AVN were treated successfully by extensive debridement, external fixation and arthrodesis. METHODS Three cases of infected AVN of the talus were encountered after a mean of 3 months (range 2-6 months) after initial reconstructive surgery. Suspected infection was confirmed by positron emission tomography scan (PET-CT). Management involved extensive debridement, PMMA cement if necessary and final fusion using medial external fixator, accompanied by culture guided antibiotics. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS). Quality of life (QOL) was measured by the EuroQol-5D (EQ-5D). RESULTS After a mean follow up of 24 months (range 13-29), FFI index scores ranged from poor to good (23, 50, 56) with similar AOFAS scores indicating poor to fair functional outcome (38, 41, 71). The EQ-5D score was 0.78. Overall patient satisfaction was high with a mean VAS of 8.3 (range 8-9). CONCLUSION Infected talar AVN is a rare condition associated with severe long-term morbidity in term of joint function. The authors recommend extensive debridement and arthrodesis by means of external fixation, followed by post-operative culture-guided antibiotics for the treatment of infected avascular necrosis of traumatic talar fractures. Shared decision-making and expectation management are of crucial importance and may lead to high patient satisfaction despite low functional outcomes. LEVEL OF EVIDENCE IV, Retrospective case series.
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Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the Talus: Current Concepts. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419900766. [PMID: 35097362 PMCID: PMC8697161 DOI: 10.1177/2473011419900766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Talus fractures continue to represent a challenging and commonly encountered group of injuries. Its near-complete articular cartilage surface, and its role in force transmission between the leg and foot, makes successful treatment of such injuries a mandatory prerequisite to regained function. Familiarity with the complex bony, vascular, and neurologic anatomy is crucial for understanding diagnostic findings, treatment indications, and surgical techniques to maximize the likelihood of anatomic bony union. This review details the structure and function of the talus, a proper diagnostic workup, the treatment algorithm, and post-treatment course in the management of talus fractures.
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Affiliation(s)
- Andrew M Schwartz
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - William O Runge
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | - Jason T Bariteau
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
OBJECTIVE To determine whether increased surgeon and hospital volume is associated with lower rates of complications after tarsal fractures. DESIGN Retrospective cohort study of the State Inpatient Databases. SETTING Two hundred ninety-nine hospitals in Florida (2005-2012) and New York (2006-2008). PATIENTS/PARTICIPANTS Four thousand one hundred thirty-two tarsal fractures that underwent fixation by 1223 surgeons. INTERVENTION Surgical repair of tarsal fractures. MAIN OUTCOME MEASUREMENTS Composite of readmission for infection requiring operative treatment, wound dehiscence, nonunion, avascular necrosis, or amputation within 2 years of the index procedure. RESULTS The mean age was 44 (±15) years, a majority were men (70%) and white (69%), and the mean number of Charlson comorbidities was 0.21 (±0.58). Multivariable logistic regression demonstrated a reduction in the likelihood of complications by 9% for each 5 additional surgeries performed by the operating surgeon [odds ratio (OR), 0.91 per 5 surgeries; 95% confidence interval (CI), 0.82-0.99]. Other factors associated with complications included increased age (OR, 1.23 per 10 years; 95% CI, 1.10-1.36), male sex (OR, 1.56; 95% CI, 1.12-2.17), open fractures (OR, 2.84; 95% CI, 1.92-4.19), number of Charlson comorbidities (OR, 1.23; 95% CI, 1.02-1.48), income quartile (OR, 1.48; 95% CI, 1.00-2.17), uninsured (OR, 2.47; 95% CI, 1.39-4.39), and other government program insurance (OR, 1.52; 95% CI, 1.06-2.18). CONCLUSIONS We observed a significant inverse relationship between surgeon volume and complication rates when controlling for patient and injury characteristics. In contrast to previous research, a volume-outcome relationship was not observed at the hospital level. These results suggest that such complex injuries should be triaged to the most experienced providers. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hierro-Cañas F, Andrés-Cano P, Rabadán-Márquez G, Giráldez-Sánchez M, Cano-Luis P. Talus fractures. Functional results for polytraumatized patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lahrach K, El Kadi KI, Marzouki A, Boutayeb F. Talar body fracture combined with medial malleolar fracture: a case report and literature review. Pan Afr Med J 2019; 32:57. [PMID: 31223349 PMCID: PMC6560992 DOI: 10.11604/pamj.2019.32.57.6166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Fracture of the talar body is rare, it reaches articular congruence and determines the ankle's functional prognosis. The authors report a case of a combination of a sagittal talar body fracture with fracture of the medial malleolus in a 52-year-old following a road traffic accident. The association talus body fracture with a medial malleolus fracture is exceptional. Stable internal fixation can yield good functional results.
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Affiliation(s)
- Kamal Lahrach
- Department of Orthopedic Surgery A, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Fès, Morocco
| | - Khalid Ibn El Kadi
- Department of Orthopedic Surgery A, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Fès, Morocco
| | - Amine Marzouki
- Department of Orthopedic Surgery A, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Fès, Morocco
| | - Fawzi Boutayeb
- Department of Orthopedic Surgery A, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Fès, Morocco
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Hierro-Cañas FJ, Andrés-Cano P, Rabadán-Márquez G, Giráldez-Sánchez MA, Cano-Luis P. Talus fractures. Functional results for polytraumatized patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:336-341. [PMID: 31078442 DOI: 10.1016/j.recot.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Talar fractures are uncommon lesions (0.1-0.9%) and have a high rate of complications. One of the situations in which a fracture of the talus can occur is in the context of polytrauma which may further compromise the functional prognosis. The aim of this study was to analyze the functional results in patients with talar fractures whether or not they occurred in the context of polytrauma. Observational study on a retrospective cohort of 24 patients operated in our centre (2008-2016). They were grouped according to whether they were polytraumatized (ISS>16) or not (ISS≤16). Review of sociodemographic, radiographic, functional variables (VAS pain scale and FADI -Foot and Ankle Disability Index-) and the onset of complications such as arthrosis, arthrodesis or avascular necrosis. Review of 25 talar fractures in 24 patients with a mean age of 38 years (19-75) and a mean follow-up of 4.2 years (0.5-9). According to the ISS, 44% of patients (11) were polytraumatized and 56% (14) were not. The average score according to the FADI scale was 62 points for the polytraumatized patients and 76.9 for the non-polytraumatized patients. The pain according to the VAS scale was 5.8 points in the group of polytraumatized patients and 4.3 in the non-polytraumatized patient group. Regarding complications, 64% of the polytraumatized patients and 43% of the non-traumatized patients had a complication. 36% of the polytraumatized patients had clinical and radiological signs of subtalar arthrosis compared to 35% of the non-traumatized patients, of whom 27% underwent arthrodesis compared to 28% of the non-traumatized patients. 27% of the polytraumatized patients were diagnosed with avascular necrosis as opposed to 0% of the non-polytraumatized patients.
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Affiliation(s)
- F J Hierro-Cañas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - P Andrés-Cano
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - G Rabadán-Márquez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M A Giráldez-Sánchez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Cano-Luis
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Vetter SY, Steffen K, Swartman B, Schnetzke M, Keil H, Franke J, Grützner PA, Beisemann N. Influence of intraoperative conventional fluoroscopy versus cone beam CT on long-term clinical outcome in isolated displaced talar fractures. J Orthop Surg Res 2019; 14:8. [PMID: 30621768 PMCID: PMC6323861 DOI: 10.1186/s13018-018-1043-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective of the study was to compare the radiologic and clinical outcome of patients with an isolated displaced talus fracture treated intra-operatively with either conventional fluoroscopy or additional cone beam computed tomography (CT). METHODS Conventional intraoperative fluoroscopy was performed in group 1 and cone beam CT was added in group 2. Clinical outcome was assessed using the Foot Function Index (FFI), American Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Short-Form 12 (SF-12) survey. In addition, the Kellgren-Lawrence score using X-rays was determined. RESULTS Overall, 24 cases were examined (group 1: 8 cases; group 2: 16 cases), with a mean follow up of 6.66 years. The FFI (group 1: 28.85 ± 22.78; group 2: 14.96 ± 15.11 points; p = 0.768), the AOFAS (group 1: 69.00 ± 24.71; group 2: 78.79 ± 17.07 points; p = 0.438), and the physical and mental component of the SF-12 (group 1: 44.79 ± 12.55; group 2: 47.63 ± 10.69 points; p = 0.136) (group 1: 46.19 ± 9.72; group 2: 53.57 ± 8.51; p = 0.242) did not differ significantly. Osteoarthritis of the talonavicular, subtalar, and ankle joints assessed using the Kellgren-Lawrence score appeared to be minor in the cone beam CT group but did not show significant differences (p = 0.309; p = 0.663; p = 0.082 respectively). DISCUSSION Intraoperative cone beam CT in addition to conventional fluoroscopy might be beneficial in the operative treatment of talar fractures but a statistical significance could not be demonstrated.
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Affiliation(s)
- Sven Y Vetter
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Kira Steffen
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Holger Keil
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmannstr. 13, 67071, Ludwigshafen, Germany.
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Vints W, Matricali G, Geusens E, Nijs S, Hoekstra H. Long-Term Outcome After Operative Management of Talus Fractures. Foot Ankle Int 2018; 39:1432-1443. [PMID: 30132701 DOI: 10.1177/1071100718790242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Controversies remain regarding the preferred treatment strategy for talus fractures. The primary goal of this study was to evaluate the long-term outcome after operative management of talus fractures. Secondarily, we identified those factors that affected the outcome and defined strategies to improve the outcome. METHODS: This is a retrospective outcome study of 84 patients with an average follow-up time of 9.1 years. We assessed the functional results, return to daily activities, and general health status using the Foot Function Index-5pt, a numeric rating scale for pain, and the Short Form-36 Health Survey. Furthermore, we conducted a correlation analysis between the outcomes and 14 demographic, clinical, and radiologic variables. RESULTS: We found moderate mean Foot Function Index pain and disability scores of 30.2 and 28.7, respectively. The mean numeric rating scale score was 3.2. Of all responders, 41% (27/66) did not return to their daily activities. We reported low physical, but good mental, Short Form-36 component summary scores of 42.7 and 48.3, respectively. We recorded a complication rate of 56%. Osteoarthritis, articular incongruence and talus body fractures correlated significantly with a poorer functional outcome. Delayed surgery after trauma was associated with better outcome measures. CONCLUSIONS: Talus fractures have a major long-term impact on ankle and hindfoot function and on physical health. Success of operative treatment depends on the occurrence of osteoarthritis postoperatively, type of fracture, and quality of fracture reduction. Because only the latter is modifiable, efforts should be made to restore articular congruence in order to improve the outcome. Therefore, we recommend reviewing the quality of the reduction postoperatively on CT. Furthermore, talus fractures should not be considered operative emergencies, but rather treated after recovery of the soft-tissues. LEVEL OF EVIDENCE: Level III, comparative study.
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Affiliation(s)
- Wouter Vints
- 1 Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Matricali
- 2 Department of Orthopaedic surgery, University Hospitals Leuven, Leuven, Belgium.,3 Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium.,4 Institute for Orthopaedic Research and Training (IORT), KU Leuven-University of Leuven, Leuven, Belgium
| | - Eric Geusens
- 5 Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Stefaan Nijs
- 1 Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.,3 Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
| | - Harm Hoekstra
- 1 Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.,3 Department of Development and Regeneration, KU Leuven-University of Leuven, Leuven, Belgium
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Abstract
Fractures of the lateral and the posterior processes of the talus are uncommon and frequently missed because of a low level of suspicion and difficulty in interpretation on plain radiographs. Missed fractures can lead to persistent pain and reduced function. Lateral process fractures are usually a consequence of forced dorsiflexion and inversion of fixed pronated foot. These are also commonly known as snowboarder’s fractures. The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon. The usual mechanism of injury is forced hyperplantarflexion and inversion causing direct compression of the posterior talus, or an avulsion fracture caused by the posterior talofibular ligament. CT scans are helpful in cases of high clinical suspicion. There is a lack of consensus regarding optimal management of these fractures; however, management depends on the size, location and displacement of the fragment, the degree of cartilage damage and instability of the subtalar joint. Non-operative treatment includes immobilization and protected weight-bearing for six weeks. Surgical treatment includes open reduction and internal fixation or excision of the fragments, depending on the size. Fractures of the lateral and the posterior processes of the talus are uncommon but important injuries that may result in significant disability in cases of missed diagnosis or delayed or inadequate treatment. Early diagnosis and timely management of these fractures help to avoid long-term complications, including malunion, nonunion or severe subtalar joint osteoarthritis.
Cite this article: EFORT Open Rev 2018;3:85-92. DOI: 10.1302/2058-5241.3.170040
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de Kruijff LGM, Prins M, van der Krans A, Hoencamp R, van der Wurff P. Combat-related foot injuries: impact on gait and functional outcome. J ROY ARMY MED CORPS 2018; 164:322-327. [DOI: 10.1136/jramc-2017-000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/04/2022]
Abstract
IntroductionPrior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.MethodIn nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.ResultsSignificant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).ConclusionsThis study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.Clinical TrialThe Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).
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Bretschneider H, Rammelt S. Combined Ipsilateral Fracture of the Tibial Pilon, Talar Body, and Calcaneus: Outcome at 4 Years. Indian J Orthop 2018; 52:334-338. [PMID: 29887638 PMCID: PMC5961273 DOI: 10.4103/ortho.ijortho_412_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Combined fractures of the talar body and the adjacent bones are rare. We present a case of a 35-year-old male with a complex foot and ankle trauma resulting in an unusual combined ipsilateral fracture of the anterolateral tibial plafond, talar body, and sustentaculum tali of the calcaneus. To the best of our knowledge, this particular combination of fractures has not yet been reported in the literature. The combination of talar body fracture with fractures of the adjacent bones was treated by a bilateral open reduction with anatomic reconstruction of the joint surfaces resulting in an excellent clinical outcome at 4-year followup.
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Affiliation(s)
- Henriette Bretschneider
- University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
| | - Stefan Rammelt
- University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany,Address for correspondence: Prof. Stefan Rammelt, University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus at TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. E-mail:
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J R B, Ma A, W K, A OG. The Diagnosis, Management and Complications Associated with Fractures of the Talus. Open Orthop J 2017; 11:460-466. [PMID: 28694883 PMCID: PMC5481613 DOI: 10.2174/1874325001711010460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/24/2017] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
Fractures of the talus are uncommon injuries that can have devastating consequences. The blood supply to the talus is tenuous and injuries are associated with a higher incidence of avascular necrosis and malunion. Talar neck fractures are the most common fractures. This review looks at the different types of fractures of the talus, particularly focusing on talar neck fractures. The diagnosis and management are discussed as well as the complications.
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Affiliation(s)
- Barnett J R
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Ahmad Ma
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Khan W
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - O' Gorman A
- Department of Trauma and Orthopaedics, The Whittington Hospital, Magdala Ave, London, N19 5NF, UK
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Maher MH, Chauhan A, Altman GT, Westrick ER. The Acute Management and Associated Complications of Major Injuries of the Talus. JBJS Rev 2017; 5:e2. [DOI: 10.2106/jbjs.rvw.16.00075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Young KW, Park YU, Kim JS, Cho HK, Choo HS, Park JH. Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas. Clin Orthop Surg 2016; 8:303-9. [PMID: 27583114 PMCID: PMC4987315 DOI: 10.4055/cios.2016.8.3.303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/31/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. METHODS Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. RESULTS In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). CONCLUSIONS A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.
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Affiliation(s)
- Ki-Won Young
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Young-Uk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Su Kim
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hun-Ki Cho
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Ho-Sik Choo
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jang-Ho Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Talar head fracture: A case report, systematic review and suggested algorithm of treatment. Foot (Edinb) 2015; 25:258-64. [PMID: 26481786 DOI: 10.1016/j.foot.2015.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/10/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Talar head fractures are uncommon. This rarity contributes to the lack of structure and clarity in its management. The purpose of this systematic review is to analyse the published literature on management of these injuries and suggest a treatment plan that was followed in our case. METHODS A search of Medline, EMBASE, AMED and Google Scholar was performed on 1st September 2014. Any article reporting case(s) of talar head fractures were included and studies of other anatomical types of talar fractures, stress fractures or paediatric cases were excluded. The paucity of data precluded data synthesis and instead a narrative synthesis was performed. RESULTS Of 45 studies identified, five publications with seven case reports met the inclusion criteria. One occurred secondary to snowboarding, one wakeboarding, one inversion injury whilst walking and one gymnastic injury. Two patients were managed operatively and two non-surgically with one requiring surgery for a symptomatic mal-union. CONCLUSION Talar head fractures are rare and high quality literature regarding management of these injuries is lacking. A suggested algorithm for treatment is proposed, but further robust studies are required to substantiate this approach.
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Abstract
OBJECTIVES To report the rates of osteonecrosis and subtalar arthritis after talar neck fractures and to examine if rates have changed over time. DATA SOURCES A systematic review and meta-analysis of the English literature was performed using EMBASE, MEDLINE, CENTRAL, and Cochrane in November 2011 and updated in November 2014. STUDY SELECTION Inclusion criteria were studies examining talar neck fractures that reported talar body osteonecrosis rates as a primary or secondary outcome. Exclusion criteria included case series with <10 patients or >50% pediatric patients, inability to isolate results of talar neck fractures, primary treatment of talar excision or arthrodesis, mean follow-up of <3 months, and non-English literature. DATA EXTRACTION Basic information was collected including journal, author, year published, level of evidence, number of fractures, and follow-up length. Specific information collected included fracture classifications, timing of interventions, method of treatment, osteonecrosis rates, subtalar arthrosis rates, and method of diagnosis of osteonecrosis. DATA SYNTHESIS Fixed-effects models were used for meta-analysis. The overall event rate of osteonecrosis was calculated and stratified based on Hawkins classification of the talar neck fractures. Mean rates of subtalar arthritis were calculated for all studies and for studies including >2 years of follow-up. CONCLUSIONS The overall rate of osteonecrosis was 0.312. Rates for Hawkins' types I-IV were 0.098, 0.274, 0.534, and 0.480, respectively. The mean rate of subtalar arthritis was 0.49 but increased to 0.81 in studies with >2 years of follow-up. Complication rates are high in talar neck fractures, and patients should be counseled accordingly.
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Avulsion fractures in the foot: telltale radiographic signs to avoid mismanagement. Clin Imaging 2014; 39:374-9. [PMID: 25482353 DOI: 10.1016/j.clinimag.2014.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/12/2014] [Accepted: 11/15/2014] [Indexed: 11/22/2022]
Abstract
Due to similar clinical presentations, avulsion fractures are frequently missed on initial exam and categorically treated as "sprain" not otherwise specified. However, delays in appropriate diagnosis and treatment can result in further injury and long-term disability. This article will review multiple foot avulsion fractures, their respective mechanisms of injury, the clinical and radiographic presentations, and the most appropriate courses of treatment.
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Krause M, Rupprecht M, Mumme M, Püschel K, Amling M, Barvencik F. Bone microarchitecture of the talus changes with aging. Clin Orthop Relat Res 2013; 471:3663-71. [PMID: 23893363 PMCID: PMC3792264 DOI: 10.1007/s11999-013-3195-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined. QUESTIONS/PURPOSES The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex. METHODS Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30). RESULTS The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex. CONCLUSIONS Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age. CLINICAL RELEVANCE Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.
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Affiliation(s)
- Matthias Krause
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Martin Rupprecht
- />Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany
| | - Marcus Mumme
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Klaus Püschel
- />Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Florian Barvencik
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
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Update on Talar Fracture Patterns: A Large Level I Trauma Center Study. AJR Am J Roentgenol 2013; 201:1087-92. [DOI: 10.2214/ajr.12.9918] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Abdelgaid SM, Ezzat FF. Percutaneous reduction and screw fixation of fracture neck talus. Foot Ankle Surg 2012; 18:219-28. [PMID: 23093114 DOI: 10.1016/j.fas.2012.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 01/10/2012] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fracture neck talus is a rare fracture represents about 1% of all fractures and usually due to high energy trauma. These fractures are usually associated with compromised soft tissues, concomitant skeletal fractures, or life threatening injuries. Talus has a tenuous blood supply which is affected by fracture displacement. Urgent fracture reduction±fracture fixation is mandatory. The associated injuries may make the conventional open reduction and internal fixation is impossible to be done in urgent base as it may impacts the already tenuous blood supply of talus increasing the risk of AVN and non union. Percutaneous fracture reduction and fixation can overcome this problem, and decrease complications associated with conventional open reduction and internal fixation. MATERIALS AND METHODS Between 2006 and 2008, 16 patients with talar neck fractures were operated on by percutaneous reduction of fracture and percutaneous fixation with 3.5mm cannulated screws. Injuries were classified according to modified Hawkins classification system. Patients were followed up over an average of 48 months. RESULTS 87.5% of the patients were satisfied and resumed their preoperative activities. The mean AOFAS Hind Foot Scale was 89.25 points (range: 74-100) and no poor outcomes. CONCLUSION Although the number of patients in this study is small, the results showed that, percutaneous reduction and fixation is a good treatment modality in treatment of fracture neck talus, especially in cases with increased risk of soft tissue complications and open reduction should be resort only when percutaneous reduction was failed.
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Insufficiency and Nondisplaced Fractures of the Talar Head: MRI Appearances. AJR Am J Roentgenol 2012; 199:W613-7. [DOI: 10.2214/ajr.11.7313] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
We present a literature review about implant removal after operative extremity and spine fracture treatment. The indication for implant removal procedures has become less frequent in recent years, but is still more common in Europe than for example in North America. The time required to perform a implant removal can easily exceed the planned amount. Implant removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the implant should be made with great care. Therefore good communication with the patient and thorough information about risks and benefits are essential.
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Prewitt E, Alexander IJ, Perrine D, Junko JT. Bimalleolar osteotomy for the surgical approach to a talar body fracture: case report. Foot Ankle Int 2012; 33:436-40. [PMID: 22735288 DOI: 10.3113/fai.2012.0436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Case Report
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Affiliation(s)
- Erin Prewitt
- Summa Health System, Department of Orthopaedics, Akron, OH 44310, USA.
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Abstract
The talus, a highly specialized bone with a unique anatomic design, is crucial for normal ambulation. Although uncommon, talar fractures can be potentially devastating to the patient. Although all talar fractures require appropriate diagnosis and treatment, some require surgical skill for appropriate correction. This article reviews the literature on talar fractures and their treatments.
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Affiliation(s)
- N Jake Summers
- College of Podiatric Medicine and Surgery, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA
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Abstract
Posttraumatic malalignment after talar neck fractures invariably leads to painful functional impairment. Anatomic reduction and definitive, stable osteosynthesis at the primary surgical intervention is preventative. Secondary anatomic reconstruction with joint preservation should be considered in the absence of arthrosis in the peritalar articulations. Reorientating arthrodeses should be entertained where deformity has resulted in joint incongruity and, ultimately, posttraumatic arthritis. TAA may have a role as a motion-conserving procedure in combination with adjacent subtalar and midtarsal fusions.
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Affiliation(s)
- James A Sproule
- Department of Orthopaedic Surgery, QEII Health Sciences Centre, Halifax Infirmary, 1796 Summer Street, Halifax NS, B3H 3A7, Canada.
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Hsu J, Demos TC, Lomasney LM, Mitchell EJ. Radiologic case study. Talar neck fracture with tibiotalar and posterior subtalar dislocation. Orthopedics 2012; 35:165, 246-50. [PMID: 22385590 DOI: 10.3928/01477447-20120222-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Janice Hsu
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA
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Sitte W, Lampert C, Baumann P. Osteosynthesis of talar body shear fractures assisted by hindfoot and subtalar arthroscopy: technique tip. Foot Ankle Int 2012; 33:74-8. [PMID: 22381240 DOI: 10.3113/fai.2012.0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
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Affiliation(s)
- Wolfgang Sitte
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland.
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Daghino W, Di Gregorio G, Cerlon R. Surgical reconstruction of a crush injury of the talar body: a case report. J Bone Joint Surg Am 2011; 93:e80. [PMID: 21792483 DOI: 10.2106/jbjs.j.01358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
We describe a novel closed pantalar dislocation with an associated sagittal medial talar body and medial malleolus fractures. Closed reduction was attempted unsuccessfully. Open reduction was performed, revealing a disrupted talonavicular joint with instability of the calcaneocuboid joint. This configuration required stabilisation with an external fixator. There were no signs of avascular necrosis, or arthrosis at 15 months follow but is currently using a stick to mobilise.
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Treatment of Hawkins Type II Fractures of Talar Neck by a Vascularized Cuboid Pedicle Bone Graft and Combined Internal and External Fixation: A Preliminary Report on Nine Cases. ACTA ACUST UNITED AC 2010; 69:E1-5. [DOI: 10.1097/ta.0b013e3181cda6ad] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bastos LR, Ferreira RC, Mercadante MT. ANALYSIS OF CLINICAL AND FUNCTIONAL OUTCOME AND COMPLICATIONS OF TALAR NECK FRACTURES. Rev Bras Ortop 2010; 45:362-74. [PMID: 27022565 PMCID: PMC4799135 DOI: 10.1016/s2255-4971(15)30382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the clinical, functional and radiographic results from talar neck fractures in patients treated at the Foot and Ankle Surgery Group of Santa Casa de Sao Paulo. Method: We evaluated 20 patients. The mean follow-up time was 71 months. One fracture was classified as Hawkins Type I, 12 as Hawkins type II, five as Hawkins type III, two as Hawkins type IV and four fractures were open. Results: One patient was treated conservatively, 16 were treated with open reduction and internal fixation (three with primary subtalar arthrodesis), one was treated with talectomy and two with tibiotalocalcaneal arthrodesis. The reduction obtained was anatomical in seven feet, acceptable in six feet and poor in four. Seven patients had early complications. There was one case of delayed consolidation and four of talar body osteonecrosis. Four patients required secondary reconstruction procedures. No significant radiographic impairment of the ankle joint was found in 62% of the patients and of the subtalar joint in 25%. Of the patients who did not undergo secondary procedures, 81% complained about the treated foot, 37.5% showed some deformity, 44% presented diminished sensitivity and 50% had to retire from work. The mean loss of motion in the ankle was 49%, and in the subtalar joint, 80%. The average AOFAS score was 73 points. Conclusion: Talar neck fractures are associated with high rates of clinical, functional and radiographic complications.
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Affiliation(s)
- Leonardo Ribeiro Bastos
- MSc in Medicine; Orthopedist and Specialist in Foot and Ankle Surgery; First Medical Lieutenant of the Brazilian Army, serving at the Central Hospital of the Army
| | - Ricardo Cardenuto Ferreira
- PhD in Medicine; Assistant Professor and Head of the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de Sao Paulo
| | - Marcelo Tomanik Mercadante
- PhD in Medicine; Adjunct Professor and Attending Physician in the Trauma Group, Department of Orthopedics and Traumatology, Santa Casa de Sao Paulo
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Wirth S, Euler E, Linsenmaier U, Heining SM, Kotsianos D, Pfeifer KJ, Mutschler W, Reiser M. C-arm-based mobile computed tomography: a comparison with established imaging on the basis of simulated treatments of talus neck fractures in a cadaveric study. ACTA ACUST UNITED AC 2010; 9:27-38. [PMID: 15792934 DOI: 10.3109/10929080400006309] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To analyse the image quality and diagnostic effectiveness of a new C-arm-based 3D imaging method (C-arm-CT) for intraoperative evaluation of screw osteosyntheses adjacent to a peripheral joint. MATERIALS AND METHODS Insertion of screws into four cadaveric specimens simulated the surgical treatment of talus neck fractures. Ten orthopedic surgeons and 10 radiologists evaluated X-ray, C-arm fluoroscopy, C-arm-CT and CT images. RESULTS The best image quality was obtained with X-rays (p < 0.001), followed by C-arm fluoroscopy (2D) and CT, with the C-arm-CT (3D) being rated lowest (p < 0.001). The most correct diagnoses were obtained with CT and C-arm-CT (with no statistical difference between them), while C-arm-fluoroscopy was inferior (p < 0.001) and X-rays were the worst (p < 0.05). CONCLUSIONS Even if the image quality of C-arm-CT is definitely inferior to that of CT, screw misplacements can be reliably detected using C-arm-CT. As compared to the current standard procedures (intraoperative fluoroscopy and postoperative radiography), C-arm-CT performed better. C-arm-CT is ideally suited to the intraoperative diagnosis of high-contrast inquiries like bone fragments and OS material, especially at the extremities. Coupling of the new 3D imaging to existing navigation systems is possible. C-arm-CT will support the further development and implementation of open and minimally invasive surgical procedures.
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Affiliation(s)
- Stefan Wirth
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
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Ohl X, Harisboure A, Hemery X, Dehoux E. Long-term follow-up after surgical treatment of talar fractures: Twenty cases with an average follow-up of 7.5 years. INTERNATIONAL ORTHOPAEDICS 2009; 35:93-9. [PMID: 20033158 DOI: 10.1007/s00264-009-0930-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/06/2009] [Accepted: 11/29/2009] [Indexed: 11/26/2022]
Abstract
Displaced talar neck and body fractures are rare and serious injuries with important outcomes. The aim of our study was to evaluate the long-term outcomes of these fractures after operative treatment in our centre between 1993 and 2005. Displaced talar fractures have a high rate of long-term complications. This was a retrospective study concerning 20 patients with an average follow-up of 7.5 years. The final follow-up examination included determination of the AHS score (ankle-hindfoot scale) from the American Orthopaedic Foot and Ankle Society (AOFAS), range of motion evaluation and radiological analysis. Mean age at the time of trauma was 38.8 years. This study comprised ten talar neck fractures and ten talar body fractures. We always used a single surgical approach and obtained anatomical reduction in 30% of the whole series of both groups. Four early complications were noted in four patients (20%). We noted no skin complications and the rate of consolidation was 100%. Four patients (20%) developed avascular necrosis of the talus, and at final follow-up seven patients (35%) had undergone secondary surgery. Radiographic analysis showed an osteoarthritis rate of 94% and a malunion rate of 59%. The mean AOFAS score was 66.9/100 and range of motion was systematically decreased. Contrary to undisplaced talar fractures, displaced talar fractures are a therapeutic challenge with many early or late complications. The outcome often revealed stiffness and osteoarthritis.
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Affiliation(s)
- Xavier Ohl
- CHU Maison Blanche, Service d'Orthopédie et de Traumatologie, 45 rue Cognacq Jay, 51100, Reims, France.
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Abstract
Because of the effect on hindfoot kinematics, missed or delayed diagnosis of peritalar injuries often results in impairment. The seemingly innocuous nature of these injuries, subtle radiographic findings, and low incidence limit familiarity, thereby increasing the likelihood of misdiagnosis. Because of delay in diagnosis, salvage arthrodesis may be necessary to restore function to the extremity. Talar head fracture, talar process fracture, subtalar fracture-dislocation, transverse tarsal joint fracture, and transverse tarsal ligamentous disruption with instability are recurrently misdiagnosed. The keys to proper diagnosis of these potentially devastating injuries are the recognition of their existence, their injury patterns, and their radiographic appearance. The threshold for additional imaging studies should be lowered when a patient has pain and physical examination findings are out of proportion to a provisional diagnosis, or when symptoms fail to improve.
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Rieger UM, Haug M, Schwarzl F, Kalbermatten DF, Hintermann B, Pierer G. Free microvascular iliac crest flap for extensive talar necrosis-Case report with a 16-year long-term follow up. Microsurgery 2009; 29:667-71. [DOI: 10.1002/micr.20676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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The treatment of talar body fractures with compression screws: a case series. CASES JOURNAL 2009; 2:7953. [PMID: 19830026 PMCID: PMC2740160 DOI: 10.4076/1757-1626-2-7953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 05/08/2009] [Indexed: 11/29/2022]
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.
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Rammelt S, Zwipp H. Talar neck and body fractures. Injury 2009; 40:120-35. [PMID: 18439608 DOI: 10.1016/j.injury.2008.01.021] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 01/24/2008] [Accepted: 01/28/2008] [Indexed: 02/02/2023]
Abstract
Fractures of the talar neck and body are rare and serious injuries. The vast majority are either intra-articular or lead indirectly to an intra-articular incongruity through a dislocation at the talar neck. Because of the high energy needed to produce talar fractures, they are frequently seen in multiply injured and polytraumatised patients. Open fractures and fracture-dislocations are treated as emergencies. Preoperative planning of definite internal fixation requires CT scanning. To obtain a complete intra-operative overview allowing for anatomical reconstruction of the articular surfaces and the axial deviation bilateral approaches are usually necessary. Internal fixation is achieved with screws or mini-plates supplemented by temporary K-wire transfixation in cases of marked additional ligamentous instability. The clinical outcome after talar neck and body fractures is determined by the severity of the injury and the quality of reduction and internal fixation. The timing of definite internal fixation does not appear to affect the final result. The rates of avascular necrosis (AVN) correlate with the degree of initial dislocation. Only total AVN with collapse of the talar body leads to inferior results with the need for further surgery whilst prolonged immobilisation or offloading of the affected foot is not indicated for partial AVN. Talar malunions and non-unions after inadequate treatment of displaced fractures are debiliating conditions that should be treated by surgical correction. Treatment options include corrective osteotomy by recreating the former fracture with secondary fixation, free or vascularised bone grafting and salvage by realignment and fusion of the affected joint(s).
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Affiliation(s)
- Stefan Rammelt
- Department of Trauma & Reconstructive Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
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50
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Abstract
Talar head and fracture injuries are not easily recognized and can create significant long-term disability when missed. Careful investigation of any injury about the ankle requires both clinical and radiographic examination. A computed tomography scan is extremely helpful in diagnosing and treating talus fractures. Displaced fractures require open reduction of the major joint surfaces and internal fixation. Prolonged non-weight bearing and immobilization is the norm. Despite aggressive management, complications involving avascular necrosis and posttraumatic arthritis to both the subtalar and tibiotalar joints occurs frequently.
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Affiliation(s)
- John S Early
- Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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