Surgical strategy for talar neck fractures

Abstract

Objective To explore the operative methods of treating talar neck fractures.Methods From January 2003 to January 2008, 32 patients with talar neck fractures were treated in our department. They were 22 males and 10 females, with an average age of 38. 5 years (range, 18 to 55 years).According to the modified Hawkins classification, there were 6 cases of type Ⅰ, 19 type Ⅱ, and 7 type Ⅲ.Two cases of the type Ⅰ were treated non-operatively with non-weight bearing cast for 6 to 8 weeks, and the other 4 with percutaneous screw fixation. All the patients of type Ⅱ and Ⅲ were treated operatively. Twenty-one cases were treated with open reduction and internal screw fixation, and 5 with plate fixation. Results Only 24 patients were followed up for an average of 20 months (range, 12 to 48 months) . No wound healing problems were observed. According to the Ankle and Hindfoot score system of American Orthopaedic Foot and Ankle Society (AOFAS), the mean postoperative score was 80. 5 (ranging from 60 to 96) points.Nonunion occurred in one patient of type Ⅱ who eventually responded to open reduction, bone grafting and internal fixation. Avascular necrosis of the talus head occurred in 4 patients of type Ⅲ, but without collapse of the talar body. Of them, 2 underwent conservative treatment and 2 received subtalar arthrodesis. Conclusions Satisfactory clinical results can be achieved by suitable surgical treatment according to the type of the talar neck fracture. Fractures of type Ⅰ may be treated by conservative treatment or fixation with percutaneous screws,while fractures of types Ⅱ and Ⅲ may be treated by open reduction and screw fixation. If the fracture is comminuted, plate fixation should be performed. Key words: Talus; Fractures; Fracture fixation, internal