Fixation Of Talar Neck Fractures Research Articles

Union Rates of Talar Neck Fractures with Critical Bone Defects Treated with Autograft

Category:TraumaIntroduction/Purpose:The purpose of this study was to evaluate union of talar neck fractures with critical bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. We hypothesized that acute autografting leads to reliable union rates.Methods:A case series at a Level I trauma center was performed to identify patients who underwent open reduction and internal fixation of talar neck fracture with proximal tibial autograft between 2015 and 2018. Inclusion criteria were age greater than 18 years and displaced talar neck fracture with critical bone defect treated with tibial autograft. Critical bone defect was defined as a gap greater than 5mm in the sagittal plane and greater than 1/3 of the width of the talar neck in the coronal plane. Post-operative foot CT scans were obtained for all patients to assess for union. Primary outcome was union and secondary outcomes were malunion, avascular necrosis, post-traumatic arthritis, and patient-reported outcomes (PRO) including PROMIS (Patient Reported Outcomes Measurement Information System), Foot and Ankle Measurements: Activity of Daily Living and Sports (FAAM ADL/Sports), Visual Analogue Scale for feet (VAS), Foot Function Index (FFI), and Short Form-36 (SF-36).Results:Twelve patients were included in the series. The average age was 34 years (17-59). The Hawkins classification of the fractures were four type II (33%) and eight type III (67%). Five fractures (42%) were extruded tali. Four fractures (33%) were open fractures, all being type III fractures. Union was achieved in eleven patients (92%). Nonunion occurred in one patient (8%), who had an open, extruded talus fracture and was a heavy smoker. Avascular necrosis occurred in 11 patients (92%). Ten patients (83%) had radiographic tibiotalar post-traumatic arthritis (PTA), and 12 patients (100%) developed subtalar PTA. Average PROMIS score was 37 (32-45) and average FAAM ADL and Sports was 61 (31-87) and 31 (0-71), respectively. Average VAS was 5 (0-10) and average FFI was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients.Conclusion:Tibial autograft in primary osteosynthesis of comminuted talar neck fractures with critical bone defects leads to reliable union rates and is an operative strategy that should be considered when treating these difficult fractures. Despite high union rates, secondary outcomes of AVN, PTA, and below-average PRO still occurred in the majority of patients.

Union Rates of Talar Neck Fractures With Substantial Bone Defects Treated With Autograft

This study evaluated the union rate of talar neck fractures with substantial bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. A case series at a level 1 trauma center was performed to identify consecutive patients who underwent operative fixation of talar neck fracture with autograft (Current Procedural Terminology codes 28445 and 20902) between 2015 and 2018. "Substantial bone defect" was defined as a gap greater than 5 mm in the sagittal plane and greater than one-third of width of the talar neck in the coronal plane. Postoperative foot computed tomographic (CT) scans were obtained for all patients. Primary outcome was union, and secondary outcomes were malunion, avascular necrosis (AVN), post-traumatic arthritis (PTA), and patient-reported outcomes (PROs). Twelve patients with 12 fractures were included in the series, with an average length of follow-up of 26 months (range: 7-55) The average age was 34 years (17-59), and the most common mechanism of injury was motor vehicle crash. The Hawkins classification of the fractures was 4 type II (2 type IIA and 2 type IIB) (33%) and 8 type III (67%). Four fractures (33%) were open fractures. Union was achieved in 11 patients (92%). There was 1 malunion (8%). AVN was identified on postoperative CT scans in 11 patients (92%). Three of these 11 eventually showed collapse. Ten patients (83%) had radiographic evidence of some degree of ankle PTA, and 12 patients (100%) had radiographic evidence of some degree of subtalar PTA. Average Patient-Reported Outcomes Measurement Information System-Short Form score was 37 (32-45) and average Foot and Ankle Ability Measure activities of daily living and sports subscale scores were, respectively, 61 (31-87) and 31 (0-71), respectively. Average visual analog scale score was 5 (0-10), and average Foot Function Index was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients. In this relatively small series, tibial autograft in primary osteosynthesis of comminuted talar neck fractures with substantial bone defects is associated with excellent union rates and low malunion rates. Despite high union rates, secondary outcomes of AVN with or without collapse, ankle and subtalar PTA, and relatively low PROs were common. Level IV, case series.

Arthroscopically assisted fixation of Hawkins type II talar neck fractures: a case series.

Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures. A total of seven consecutive patients (four women and three men, mean age 39 years (19 to 61)) underwent attempted surgical treatment of a closed Hawkins type II talar neck fracture using arthroscopically assisted reduction and percutaneous screw fixation. Functional and radiological outcome were assessed using plain radiographs, as well as weight-bearing and non-weight-bearing CT scans as tolerated. Patient satisfaction and pain sensation were also recorded. Primary reduction was obtained arthroscopically in all but one patient, for whom an interposed fracture fragment had to be removed through a small arthrotomy to permit anatomical reduction. The quality of arthroscopic reduction and restoration of the talar geometry was excellent in the remaining six patients. There were no signs of talar avascular necrosis or subtalar degeneration in any of the patients. In the whole series, the functional outcome was excellent in five patients but restricted ankle movement was observed in two patients. All patients had a reduction in subtalar movement. At final follow-up, all patients were satisfied and all but one patient were pain free. Arthroscopically assisted reduction and fixation of talar neck fractures was found to be a feasible treatment option and allowed early functional rehabilitation. Cite this article: Bone Joint J 2018;100-B:461-7.

Clinical and surgical outcome following surgical management of talar neck fractures

Fractures of the talar neck & body remain a challenge to the treating surgeon due to the serious nature of the injury and to the potential complications of the treatment. Displaced fracture of the talar neck is associated with a high percentage of permanent disability. The key for the treatment of talus fracture is knowledge of anatomy and the blood supply Aim of the Study: The aim of the study was to analyze Incidence, age, sex, mechanism of injury, Types of fractures and dislocations, Effectiveness of different methods of fixation, period for union of fractures, complications and their management, Functional outcome. Clinical Material and Methods: Forty two patients were treated for fracture of talar neck at our institution. This study was conducted retrospectively and prospectively Fractures were classified according to HAWKIN’S classification with modification from S. Terry Canale. Three of them belong to type one (undisplaced); eighteen were type 2; nineteen were type 3; two type 4. The compound factures were classified according to Gustillo and Anderson. Road traffic accident was the cause of trauma in twenty two, fall from height being cause of injury in nineteen, one patient had fall of stone slab on the foot. Treatment: Forty patients underwent surgery for the fixation of talar neck fractures. Thirty four of the fractures were operated with in twenty four hours after injury of the 40 patients who underwent fixation, open reduction and internal fixation was done in thirty two patients (seventeen type 3, twelve type 2, two type 4, one type 1). Cannulated /cancellous screws were used to fix talus in seventeen patients (16 antegrade, anteromedial to posterolateral. One posterolateral to anteromedial), Orthofix pins were used in eleven patients, K- wire used in twelve of them. All the fractures were evaluated at the end of six weeks after surgery. Plaster cast removed and radiological evaluation of the fracture was done and below knee cast re applied. In the evidence of fracture union active mobilisation started with strict non weight bearing continued until sound fracture union. Conclusion: Clinical management of the talar neck fractures is complex. Prompt and precise anatomic surgical reduction, preservation of the blood supply, bone grafting of the medial neck comminution, rigid internal fixation to allow joint mobilization post operatively are the guidelines to be followed to reduce poor outcomes.

Double opposing lag screws for internal fixation of talar neck fracture

Objective To report the process and clinical efficacy of internal fixation with double opposing lag screws for talar neck fractures. Methods From October 2005 to October 2012, we treated 13 patients with talar neck fracture. They were 8 males and 5 females, with a mean age of 37.9 years (range, from 26 to 56 years). According to the Hawkins classification of talar neck fractures, 2 had type I, 9 type Ⅱ, and 2 type Ⅲ. The right foot was involved in 9 of them. None of them sustained bilateral talar neck fractures. A concomitant medial malleolar fracture occurred in 4 of them. All the fractures were closed injury. All the patients received internal fixation with 2 opposing hollow screws of 3.5 mm in diameter which were inserted via the talus anterior or posterior approach and antegradely or retrogradely, respectively. Postoperative outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and visual analogue scale (VAS). Results The mean follow-up duration was 43.3 months (range, from 12 to 84 months). The mean interval required to achieve radiographic evidence of talar neck fracture healing was 10.2 weeks (range, from 9 to 12 weeks). No nonunion or malunion of the talar neck fracture or medial malleolar fracture occurred. The preoperative AOFAS ankle-hindfoot scale (5.4±4.1, from 0 to 12) was significantly improved to postoperative 89.7±8.1 (from 72 to 98) (t = 54.984, P < 0.001). Nine cases were rated as excellent, 3 as good and one as fair. The VAS pain score was significantly improved from 9.4±0.8 (from 8 to 10) preoperatively to 1.1±0.8 (from 0 to 3) postoperatively (t = 20.679, P <0.001). Conclusion Internal fixation with double opposing lag screws which are placed perpendicular to the oblique fracture line in the neck of the talus is a good operative treatment for talar neck fractures because it can provide satisfactory biomechanical stability and protect blood supply of the talus. Key words: Talus; Fractures, bone; Fracture fixation, internal; Bone screw

Talar Neck Fractures Treated Using a Highly Selective Incision: A Case-Control Study and Review of the Literature

We describe a highly selective incision combined with percutaneous manipulation for reduction and internal fixation of talar neck fractures. We retrospectively investigated the clinical data from 29 cases of talar neck fractures treated from January 2009 to June 2013. Fifteen patients (study group) were treated using a 1- to 2-cm limited incision placed on the anteromedial or anterolateral side of the talus, followed by percutaneous reduction and fixation. Another 14 patients (control group) underwent open reduction and internal fixation through a conventional anteromedial or anterolateral approach. All cases were fixed with Herbert screws or cannulated titanium screws. All the patients were followed up for a minimum of 18 (median 24) months. All the fractures displayed bony union at or before the final follow-up visit. The mean American Orthopaedic Foot and Ankle Society ankle scale score in the study group was 75.3 ± 17.7, 9 patients (60%) had good or excellent results, and 3 (20%) developed talar avascular necrosis. The mean ankle scale score in the control group was 78.9 ± 15.2, 9 patients (64.3%) had good to excellent results, and 6 (42.9%) developed avascular necrosis. No statistically significant differences were found in the American Orthopaedic Foot and Ankle Society score, the number of good to excellent outcomes, or the incidence of complications between the incision groups. A highly selective incision combined with percutaneous reduction and internal fixation can be used to treat fractures of the neck of the talus satisfactorily.

Study on secure tunnel in the fixation of talar neck fracture based on digital technology

Objective To investigate the establishment of secure tunnel in fixation for the talar neck fracture when screws were fixed from the medial wall of talus.Methods The age of volunteers was limited from 20 to 60 years old,and the height of male volunteers was from 165 to 185 centimeters,while the female volunteers' height was from 155 to 175 centimeters.The body mass index (BMI) was less than 25.The volunteers who were not heavy manual workers or standing working for long time had no history of ankle or foot fractures,and there were no evidence of degeneration changes in ankle joints according to X-ray.At last there were 33 males in this study with an average age of 43.7 (21-59) years and an average height of 176.0 (168-184) centimeters.There were 22 females with an average age of 43.2 (22-60) years and an average height of 165.4 (158-172) centimeters.After the volunteers' ankle joints and feet were scanned by CT,the reconstructed images were stored in CD and the slice thickness was 0.75 millimeters.The SuperImageTM Orthopedics Edition1.1 software was used to display the images and perform three dimensional reconstruction.The height of talar neck and the height of tarsal canal were measured.The models that screws passing into tarsal canals were built.The maximal length and angle that screws were inserted in the middle 1/3 and in the inferior 1/3 of medial wall of talus and run along to two directions were measured.At last,the data were analyzed with SPSS 13.0 software.Results The height of talar neck and tarsal canal had no significant difference between left side and right side in the same gender.The height of male talar neck was greater than the female' s.The models of screws passing into tarsal canals was gained.The length and angle in different insert points and different directions of screw fixation were also gained.When the screws were inserted from the middle 1/ 3 of the medial wall of talus,the angle of screw fixation was much wider than that when the screws were inserted from the inferior 1/ 3 of the medial wall of talus.At last,the safe range of the length and angel of screw fixation was calculated.Conclusion Damage of the blood of talus during internal fixation should be avoided.The middle 1/3 of the medial wall of talus is the most favourable choice to the fixation.Combining the digital technology with internal fixation for talar neck fracture could promote the operation' s security and feasibility. Key words: Talus; Fractures, bone; Internal Fixators; Computers, analog

Talar Neck Fractures: Results and Outcomes

Talar neck fractures occur infrequently and have been associated with high complication rates. The purposes of the present study were to evaluate the rates of early and late complications after operative treatment of talar neck fractures, to ascertain the effect of surgical delay on the development of osteonecrosis, and to determine the functional outcomes after operative treatment of such fractures. We retrospectively reviewed the records of 100 patients with 102 fractures of the talar neck who had been managed at a level-1 trauma center. All fractures had been treated with open reduction and internal fixation. Sixty fractures were evaluated at an average of thirty-six months (range, twelve to seventy-four months) after surgery. Complications and secondary procedures were reviewed, and radiographic evidence of osteonecrosis and posttraumatic arthritis was evaluated. The Foot Function Index and Musculoskeletal Function Assessment questionnaires were administered. Radiographic evidence of osteonecrosis was seen in nineteen (49%) of the thirty-nine patients with complete radiographic data. However, seven (37%) of these nineteen patients demonstrated revascularization of the talar dome without collapse. Overall, osteonecrosis with collapse of the dome occurred in twelve (31%) of thirty-nine patients. Osteonecrosis was seen in association with nine (39%) of twenty-three Hawkins group-II fractures and nine (64%) of fourteen Hawkins group-III fractures. The mean time to fixation was 3.4 days for patients who had development of osteonecrosis, compared with 5.0 days for patients who did not have development of osteonecrosis. With the numbers available, no correlation could be identified between surgical delay and the development of osteonecrosis. Osteonecrosis was associated with comminution of the talar neck (p < 0.03) and open fracture (p < 0.05). Twenty-one (54%) of thirty-nine patients had development of posttraumatic arthritis, which was more common after comminuted fractures (p < 0.07) and open fractures (p = 0.09). Patients with comminuted fractures also had worse functional outcome scores. Fractures of the talar neck are associated with high rates of morbidity and complications. Although the numbers in the present series were small, no correlation was found between the timing of fixation and the development of osteonecrosis. Osteonecrosis was associated with talar neck comminution and open fractures, confirming that higher-energy injuries are associated with more complications and a worse prognosis. This finding was strengthened by the poor Foot Function Index and Musculoskeletal Function Assessment scores in these patients. We recommend urgent reduction of dislocations and treatment of open injuries. Proceeding with definitive rigid internal fixation of talar neck fractures after soft-tissue swelling has subsided may minimize soft-tissue complications.

Posterior approach for internal fixation of talar neck fractures

Internal fixation of talar neck fractures is clinically efficacious efficacious but technically difficult. Intra-articular screw placement and unstable fixation often result. The posterior approach allows stable screw fixation with good compression perpendicular to the neck fracture. Although unfamiliar to many surgeons, the approach can be safely accomplished with minimal dissection. The posterior approach is the preferred method of fixation in certain talar fracture patterns.