Anteromedial ankle approach for talus fracture

Abstract

Objective To investigate the therapeutic effect of anteromedial ankle approach for talus fracture. Methods From January 2012 to October 2018, the data of 28 cases of talus fracture treated by anteromedial ankle approach were retrospectively analyzed, including 26 males and 2 females, aged 24-61 years with an average of 38.6 years. All 25 cases of closed injuries and 3 cases of open injuries were fresh injuries. There were 16 cases of traffic injuries, 8 falling injuries, 2 heavy object injuries and 2 sprains. Among the 28 patients, 17 were talus neck fractures, and according to Hawkins talus neck fracture classification, there were 1 case of type I, 12 type II, and 4 type III. There were 11 cases of talus fracture, which were classified according to Sneppen talus fracture types: 2 cases of type I, 8 cases of type II and 1 case of type V. Among them, 2 cases of talus neck fracture complicated with T12 vertebral body fractures and 2 cases complicated with calcaneal fractures. The time from injury to operation for 3 patients with open fracture was 3-6 hours. 25 cases of closed fracture injuries took 2-10 hours to operate, with an average time of 5.6 hours. All patients were fixed with cannulated screws through the anteromedial ankle approach. The weight-bearing time and strength of lower limbs were determined according to fracture healing after surgery. The ankle function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results All 28 patients were followed up for 23 to 82 months, with an average of 37.5 months. All fractures healed. The healing time of talus neck fracture was 3.5-8 months, with an average of 5 months. The healing time of talus fracture was 3-7 months, averaging 4.5 months. At the latest follow-up, AOFAS score ranged from 68 to 100, with an average of 82.5 points, including excellent in 15 cases, good in 8 cases, fair in 4 cases and poor in 1 case, with the excellent and good rate of 82.1% (23/28). There were no signs of fracture displacement, malunion, loosening and prolapse of internal fixation, fracture and ischemic necrosis of talus after operation. Traumatic arthritis occurred in 9 patients, with an incidence rate of 32.1% (9/28). Tibial joint was involved in 5 cases, talus joint in 3 cases, tibialis in 1 case and talus joint in 1 case. Among them, traumatic arthritis occurred in 2 cases of open injury. Nine patients (32.1%) suffered from traumatic arthritis 6-10 months after operation, with an average of 8 months. According to conservative treatments such as weight control, ankle immobilization, physiotherapy, anti-inflammatory and analgesic, nutrition of articular cartilage drugs, joint traction and plasty were given. The patients' conditions improved to different degrees and could tolerate walking and normal life and work. Conclusion The anteromedial ankle approach has the advantages of minimal vessel injuries, clear exposure for direct reduction, low rate of necrosis of talus and satisfactory curative effect. Key words: Talus; Fractures, bone; Fracture fixation, internal