Treatment of talar neck fractures in older children

Abstract

Objective To summarize the experience of diagnosis and treatment of talar neck fractures in older children,aiming to provide a reliable and predictable program.Methods The clinical data of patients suffering from tallar neck fractures (June 2001-November 2009) were retrospectively reviewed.The patients included 7 males and 3 females with an average age of 13.4 years (ranging from 8 to 16 years old),among which 4 children were left talar neck fractures and 6 were right.According to the modified Hawkins classification,3 cases were type Ⅰ,5 were type Ⅱ,and 2 were Type Ⅲ.All type Ⅰ patients underwent conservative treatment with 6-8 weeks of non-weight bearing plaster external fixation,type Ⅱ and Ⅲ patients were treated with open reduction and internal fixation (ORIF).Results All patients were followed up for 23.5 months averagely (ranging 15 to 68 M),and they healed completely during follow-up period.Referring to the Hawkins scoring system,5 cases were assessed as excellent,4 as good,and 1 as fair,which means 90 percent of patients achieve satisfactory efficacy.1 case was complicated with superficial skin flap necrosis and 2 cases were complicated with talar body avascular necrosis,and recovered after further conservative treatment.Conclusions Anatomical reconstruction is essential for talar neck fractures in children; better fixation will contribute greatly to the functional recovery and mobilization in early phase of healing.Selection of therapeutic approach for pediatric talar neck fracture should refer to the individual status and fracture type.Our experience suggests that of Hawkins type Ⅰ fracture should be treated with conservative treatment,while type Ⅱ and Ⅲ should be treated with ORIF. Key words: Fractures,bone; Talus; Child