Functional outcome and quality of life in surgically treated talar neck and body fractures; how is it affected by complications

Olivier Wijers,Hafize Demirci,Fay R.K Sanders,Jens A Halm,Tim Schepers

doi:10.1016/j.injury.2022.02.013

Abstract

BackgroundSince talus fractures are rare, study populations are frequently small. The aim of this study is to describe how surgical treatment of talar neck and body fractures and postoperative complications affect functional outcome and quality of life measured by validated questionnaires. MethodsAll patients following surgically treated talar neck and/or body fracture between January 2000 and December 2019 at a level 1 trauma center were included in this retrospective cohort study. Primary outcomes were functional outcomes measured by Lower Extremity Functional Score (LEFS), the Foot Function Index (FFI), and the Quality of Life (QOL) measured by the EuroQol 5-dimension questionnaire (EQ-5D). Linear regression was used to assess the relationship between continuous variables and the outcome, and multivariable linear regression was used to identify the predictors of the functional outcome. ResultsNinety patients were included, of which 73 responded to our questionnaires. The median follow-up time was 50.5 (interquartile range (IQR), 18.3–97.3) months. Our study showed the following results: a mean LEFS of 58.4 (range, 17–80), a median FFI of 15.7 (IQR, 3.5–35.2), a median EQ-5D index score of 0.83 (IQR, 0.81–1.00), a median patient satisfaction of 9.0 (IQR, 8.0–10.0), a patient reported health status of 76.8 (range, 20–100), and a mean AOFAS score of 75.7 (range, 28–100). Implant removal and secondary arthrodesis were associated with a reduced AOFAS outcome score (p=0.001, p<0.001), and implant removal was also a predictive factor for a less favorable LEFS outcome score (p=0.001). ConclusionPatients who underwent implant removal and/or secondary arthrodesis had poorer functional outcome compared to patients who did not undergo additional procedures. Careful consideration of re-intervention must be made in combination with patient expectation management. Future studies should focus on how to lower the rate of complications and the effect of secondary intervention with the use of validated questionnaires.

Highlights

Fractures of the talus are relatively uncommon, comprising less than 1% of all fractures and 3% to 6% of foot and ankle fractures [1] .The vascular supply of the talus is predominantly extra osseous since more than half (65%) of the surface is covered by cartilage and without muscular attachments
This study describes how surgical treatment and various postoperative complications affect the functional outcome and Quality of Life in a large patient population treated in a level 1 trauma center
Less favorable functional outcomes, which influences the quality of life, were observed

Summary

Introduction

Fractures of the talus are relatively uncommon, comprising less than 1% of all fractures and 3% to 6% of foot and ankle fractures [1] .The vascular supply of the talus is predominantly extra osseous since more than half (65%) of the surface is covered by cartilage and without muscular attachments. Because talus fractures are rare, high-quality studies investigating the functional outcome and quality of life with validated questionnaires after surgically treated talar neck and body fractures are limited [5–8]. This study describes how surgical treatment and various postoperative complications affect the functional outcome and Quality of Life in a large patient population treated in a level 1 trauma center. The aim of this study is to describe how surgical treatment of talar neck and body fractures and postoperative complications affect functional outcome and quality of life measured by validated questionnaires. Methods: All patients following surgically treated talar neck and/or body fracture between January 2000 and December 2019 at a level 1 trauma center were included in this retrospective cohort study. Future studies should focus on how to lower the rate of complications and the effect of secondary intervention with the use of validated questionnaires

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