Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management

Nicolò Golin,Ilaria Fantoni,Pietro Ruggieri,Antonio Frizziero,Carlo Biz,Michele De Cicco,Nicola Maschio,Elisa Belluzzi

doi:10.1186/s12891-019-2738-2

Abstract

BackgroundThe main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management.MethodsFrom January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed.Results27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49–119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7–7). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0–11 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9–10). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%).ConclusionsDespite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF.

Highlights

The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF)
Based on the data found, we aimed to verify the influence of talar fracture location on the outcomes, the prognostic value of the well-known Hawkins sign, whether the operative delays promote
Patients In this retrospective case series study, we examined clinical and radiographic data from a consecutive series of Caucasian patients diagnosed with isolated, displaced, closed talar fractures

Summary

Introduction

The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Talar fractures are rare, accounting for less than 1% of all fractures in the human body and estimated to comprise between 3 and 6% of all foot fractures [1,2,3]. They are described as being among the most challenging injuries to manage, even for experienced orthopaedic and trauma surgeons due to their various locations and patterns, the unique anatomical shapes and the vascular anatomy of the talus bone, as well as the choice of conservative or aggressive treatment and relative timing, surgical approaches and internal fixation hardware [3,4,5,6]. Different reports published on this topic during the years - mostly retrospective, often with follow-up periods too short to discuss the outcomes critically and only a few focused on the isolated injuries - have contributed to the treatment dilemma for talus fracture-dislocations in many facilities [1,2,3, 11, 15,16,17,18,19]

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