Abstract
Introduction: Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications. The aims of the present study are: 1) to review the available evidence concerning the outcome and complications of talar neck fractures; 2) to describe the clinical results and the rate of post-op complications in a series of patients treated surgically after talar fracture-dislocations. Materials and methods: The review of the literature was performed on the Pubmed, Embase and Web of Science databases and aimed at identifying clinical trials with at least 10 patients and dealing with surgical management of talar fracture-dislocation (Hawkins grade II to IV). All the papers were analyzed to extract data concerning common complications such as non-union, mal-union, infection, osteonecrosis and osteoarthtritis. The clinical arm of this paper included 26 patients (19 men and 7 women), who underwent fixation of displaced talar fracture by cannulated screws and were retrospectively evaluated, both clinically and radiographically, at a mean 51.2 ± 23.4 months of follow-up. Results: The evaluation through the AOFAS score revelead a loss of functional performance with respect to the pre-injury status. Four patients were re-operated within final follow up, whereas the remaining 22 presented excellent results in 2 cases, good results in 4 cases, fair results in 11 cases and poor results in 5 cases. Osteoarthritis and osteonecrosis incidence were 51.9% and 25.9% respectively. Sixteen studies were included in the review and it was confirmed that the most frequent complication was post-traumatic OA, followed by osteonecrosis and mal-union. A variable range in percentage of complications described should be ascribed to the low quality of trials currently available. Conclusion: Displaced talar fracture are challenging to treat and the outcomes at middle-term are often modest. Looking at complications, the present case series and the review of literature revealed that the most common one is peritalar OA. Osteonecrosis, traditionally regarded as the most fearsome adverse event, is relevant but less frequent than OA.
Highlights
Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications
Sixteen studies were included in the review and it was confirmed that the most frequent complication was posttraumatic OA, followed by osteonecrosis and mal-union
The aims of the present manuscript are: 1) to review the available evidence concerning the risk of post-op complications that should be realistically expected following reduction and internal fixation of these challenging fracture; 2) to describe the clinical outcome and the rate of post-op complications in a series of homogenous patients treated surgically after talar neck fracture-dislocations (Hawkins grade II-IV), comparing the results obtained with those documented in the available literature
Summary
Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications. It has been documented that talar fractures represent about 2.5% of all fractures seen in Emergency departments, the most commonly site involved being the talar neck (almost 50% of all cases), followed by talar body [2]; despite being a rare condition, the treatment is always challenging: conservative approach by bracing is possible only in case of undisplaced fractures, whereas in the majority of cases it is required surgical intervention to reduce and stabilize the fracture [3] In most cases, this kind of injuries are associated to poor clinical outcome, with a high rate of serious post-op. The aims of the present manuscript are: 1) to review the available evidence concerning the risk of post-op complications that should be realistically expected following reduction and internal fixation of these challenging fracture; 2) to describe the clinical outcome and the rate of post-op complications in a series of homogenous patients treated surgically after talar neck fracture-dislocations (Hawkins grade II-IV), comparing the results obtained with those documented in the available literature
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