Talar neck fractures: results and complications by type

Abstract

Thirty-three talar neck fractures (10 Hawkins I, 10 Hawkins II and 13 Hawkins III) were treated either conservatively (nine type I, one type II and one type III), or by osteosynthesis (one type I, nine type II and 11 type III) or tibiotalar fusion (one type III). Bone consolidation time was 2.5 months for type I fractures, 4 months for type II and 4.3 months for type III (anova P < 0.001). Functional results were: 21 excellent/good results (nine type I, nine type II, three type III), two fair (type III) and 10 poor (one type I, one type II, eight type III) (P < 0.001). Among nine cases with avascular necrosis (one type I, one type II, seven type III) (P < 0.05), six had poor results and three of these required Blair fusion. Osteoarthritis was more frequently associated with type II and III fractures. There was tibiotalar (16 cases: one type I, seven type II and eight type III) and subtalar (17 cases: one type I, seven type II and nine type III) osteoarthritis in 20 patients, but only nine had poor clinical results. Type III fractures had the worst functional results. Avascular necrosis produced pain in two-thirds of fractures and half of these required secondary fusion. Osteoarthritis of the tibiotalar and subtalar joints was frequent but produced pain in only half the patients.