Double opposing lag screws for internal fixation of talar neck fracture

Abstract

Objective To report the process and clinical efficacy of internal fixation with double opposing lag screws for talar neck fractures. Methods From October 2005 to October 2012, we treated 13 patients with talar neck fracture. They were 8 males and 5 females, with a mean age of 37.9 years (range, from 26 to 56 years). According to the Hawkins classification of talar neck fractures, 2 had type I, 9 type Ⅱ, and 2 type Ⅲ. The right foot was involved in 9 of them. None of them sustained bilateral talar neck fractures. A concomitant medial malleolar fracture occurred in 4 of them. All the fractures were closed injury. All the patients received internal fixation with 2 opposing hollow screws of 3.5 mm in diameter which were inserted via the talus anterior or posterior approach and antegradely or retrogradely, respectively. Postoperative outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS). Results The mean follow-up duration was 43.3 months (range, from 12 to 84 months). The mean interval required to achieve radiographic evidence of talar neck fracture healing was 10.2 weeks (range, from 9 to 12 weeks). No nonunion or malunion of the talar neck fracture or medial malleolar fracture occurred. The preoperative AOFAS ankle-hindfoot scale (5.4±4.1, from 0 to 12) was significantly improved to postoperative 89.7±8.1 (from 72 to 98) (t = 54.984, P < 0.001). Nine cases were rated as excellent, 3 as good and one as fair. The VAS pain score was significantly improved from 9.4±0.8 (from 8 to 10) preoperatively to 1.1±0.8 (from 0 to 3) postoperatively (t = 20.679, P <0.001). Conclusion Internal fixation with double opposing lag screws which are placed perpendicular to the oblique fracture line in the neck of the talus is a good operative treatment for talar neck fractures because it can provide satisfactory biomechanical stability and protect blood supply of the talus. Key words: Talus; Fractures, bone; Fracture fixation, internal; Bone screw