Surgical treatment of talar neck fractures with Acutrak screws

Abstract

Objective To explore surgical treatment of talar neck fractures with Acutrak screw fixation plus different bone grafts.Methods From October 2006 to May 2010, 22 patients with talar neck fracture were treated operatively at our hospital.They were 14 men and 8 women, aged from 17 to 48 years (average, 33.5 yeas) .By Hawkins classification, there were 4 cases of type Ⅰ, 11 cases of type Ⅱ and 7 cases of type Ⅲ.All cases received internal fixation with Acutrak screws.The Hawkins type Ⅰ cases were treated by minimally invasive percutaneous fixation.The type Ⅱ cases were treated by open reduction & internal fixation (ORIF) through the medial approach plus autologous iliac grafting.The type Ⅲ cases were treated by ORIF plus reversed transfer of vascularized fibular flap.Weight-bearing was not allowed for all cases of Ⅱ and Ⅲ type until fracture healed under plaster immobilization.Results All patients were followed up for an average of 2.8 years (from 2 to 4 years).All fractures healed without osteonecrosis or early complications.According to Hawkins criteria, 9 cases were rated as excellent, 7 as good, 4 as fair and 2 as poor,with an excellent to good rate of 72.7%.But 2 cases presented with posttraumatic tibiotalar arthritis and 3 with posttraumatic subtalar arthritis.Conclusions For talar neck fractures, Acutrak screws can provide better fixation than hollow screws and absorbable screws.Different surgical methods, such as closed percutaneous fixation, autologous iliac grafting and reversed transfer of vascularized fibular flap, should be recommended for different types of talar neck fracture. Key words: Talus; Fractures; Fracture fixation, internal; Bone grafting