Treatment Of Talar Neck Fractures Research Articles

Comparison of different internal fixation implants in the treatment of talar neck fractures: A finite element analysis.

This study aimed to analyze the biomechanics of cannulated screws (CS) with or without a lateral locking plate (LLP) in talar neck fractures through a finite element analysis. The computed tomography image of the talus from a healthy volunteer (adult male) was used to reconstruct a three-dimensional talar model. The method for fixing talar neck fractures with CS and an LLP was planned using computer-aided design software. Afterward, the three-dimensional models of comminuted talar neck fractures were used to simulate fixation with anteroposterior parallel dual CS, single CS+LLP, and dual CS+LLP. Finally, finite element analysis was carried out to compare the outcomes of dual CS+LLP to those of single CS+LLP and to those of using dual CS alone. The displacement and von Mises stress values of the three groups with different internal fixation were analyzed. For a simple talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.407 mm), while dual CS (0.459 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (5.38 MPa), while dual CS (8.749 MPa) showed the highest amount of total peak stresses. For a comminuted talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.398 mm), while dual CS (0.408 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (129.9 MPa), while dual CS (205.9 MPa) showed the highest amount of peak stresses. Compared to the other two groups, the dual CS+LLP group had better biomechanics properties in the displacement and stress peak of the talus and implant. Thus, the use of dual CS+LLP fixation is recommended for the surgical treatment of comminuted talar neck fractures.

A comparative study of three different approaches in treatment of talar neck fractures

PurposeThe primary objective of this study was to observe and compare the radiographic and clinical outcomes among three different approaches which are anteromedial, anterolateral and combined approach in patients of talar neck fractures. The secondary objective was to observe various complications. Material and methodA total of 30 patients underwent open reduction and internal fixation (ORIF) from September 2018 to march 2020 were selected retrospectively. 10 patients were there in each group. Talar neck fractures were classified according to Hawkins classification. All patients underwent ORIF with 4 mm Herbert screws. The follow-up examination included radiological evaluation, clinical and functional outcomes according to American Orthopaedic Foot and Ankle Society hind-foot score (AOFAS). Results30 patients were followed up for an average of 20.85 months (range 16–24). The mean time to bony union was 17.25 weeks, 17.35 weeks and 15.92 weeks in groups operated with anteromedial approach, anterolateral approach and combined approach respectively. The mean AOFAS hind-foot score was 76.34, 77.16 and 78.34 at 18th month follow-up in all three groups respectively. In each group, 1 patient had deep wound infection and 2 patients had superficial wound infection. Subtalar arthritis was the most common complication. ConclusionThere is no significant difference between the three groups in terms of AOFAS hind-foot score, further combined approach provides better visualization of talus fractures and early bony union but it takes longer duration of surgery with increased post-operative complications in comparison with other two groups.

Arthroscopic-assisted fracture reduction combined with robot-navigated nail placement to treat talar neck fractures

This study aims to explore the clinical efficacy of arthroscopic-assisted reduction combined with robot-navigated nail placement in the treatment of talar neck fractures. The clinical data of 13 patients with talar neck fracture in Xuzhou Benevolent Hospital from January 2018 to January 2021 were analyzed in the retrospective study. Among them, there were 9 males and 4 females, aged (36±12) years; there were 8 cases suffered on the right and 5 cases on the left. All patients were reset under arthroscopy and cannulated screws were placed in combination with three-dimensional navigation and positioning of orthopedic robot. The wounds and complications were observed in the postoperative follow-up. The activities of bilateral ankle dorsiflexion and plantar flexion were measured in the last follow-up. The visual analogue scale score (VAS) of pain in the affected feet before operation were compared with that at the last follow-up. The ankle and hind foot work energy scale of American Foot and Ankle Association (AOFAS) was used to assess the ankle function. The results showed that the wounds of 13 patients healed in one stage. The operation time was (95±45) min and the blood lose was (45±10) ml. All the patients were followed-up for (15.0±3.5) months. Two cases developed subtalar arthritis without talus necrosis and fracture nonunion. At the last follow-up, there was no significant difference in the dorsal extension and plantar flexion of the ankle between the affected side and the healthy side (25.8°±1.9° vs 26.2°±2.3°, 44.2°±2.7° vs 44.7°±2.8°, both P>0.05). The VAS score of pain in the affected foot at the last follow-up was 0.53±0.18, it was significantly lower than that before operation (0.87±0.29) (P<0.001). The mean AOFAS ankle and hind foot energy scale of the ankle function was 93.5 at the last follow-up. It's showed that treatment of talus neck fracture with arthroscopy assisted and robot guided nail placement is satisfactory and is worthy of clinical promotion.

Repair of a Comminuted Talar Neck Fracture using a Cellular Bone Allograft combined with a Textured Allograft Wedge

Category:Trauma; AnkleIntroduction/Purpose:Talar neck fractures are uncommon and are characterized by displacement, comminution, and soft tissue injury. Treatment of talar neck fractures while avoiding complications, such as osteonecrosis and long-term morbidity, presents a unique challenge to surgeons. One option for treating talar neck fractures is cellular bone allograft containing viable lineage- committed bone cells (V-CBA), which provides the osteoconductive, osteoinductive, and osteogenic properties needed for bone formation. Additionally, a structural textured allograft (STA) wedge designed to resist migration and sustain compressive force can also be used in repairing talar neck fractures. This case study describes the successful repair of a comminuted talar neck fracture using V-CBA combined with an STA wedge.Methods:A 46-year-old male patient sustained a talar neck fracture following a fall from a 12-foot ladder. Radiographic and computed tomography (CT) imaging revealed significant comminution, consequent varus angulation, and a large bony void, as well as dislocation of the posterior subtalar joint. The patient was otherwise healthy with no comorbidities. Open reduction internal fixation was performed laterally to reduce the posterior subtalar dislocation. Medially, a 6.5mm STA wedge was used to correct the varus deformity and 1cc of V-CBA was used to fill the void.Results:At 6 months, the talar neck fracture had healed with solid osseous consolidation evident on radiographic images.Conclusion:These results demonstrate that an STA wedge, with a textured design that resists migration, used in combination with a V-CBA successfully repaired a comminuted talar neck fracture.

Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures.

Screws placed from posterior to anterior have been shown to be biomechanically and anatomically superior in the fixation of talar neck and neck-body fractures, yet most surgeons continue to place screws from an anterior start point. The safety and efficacy of percutaneously applied posterior screws has not been clinically defined, and functional outcomes after their use is lacking. After institutional review board approval, we performed a retrospective review of 24 consecutive talar neck fractures treated by a single surgeon that utilized posterior-to-anterior screw fixation. Clinical, radiographic, and functional outcomes were assessed at a minimum follow-up of 12 months. Functional outcomes including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud-Molander Scores, and the Short Form 36 (SF-36) measurement were collected and reviewed. Average patient follow-up was 44 months. According to the classification system of Canale and Kelly, there were 4 type I fractures, 15 type II fractures, 4 type III fractures, and 1 type IV fracture. Four patients had open fractures. One superficial wound infection occurred, 1 patient reported FHL stiffness, and 6 complained of numbness or paresthesias in the distribution of the sural nerve (5 transient, 1 permanent). One reoperation was required to exchange a screw impinging on the talonavicular joint. Radiographically, 44% developed a positive Hawkins sign, and the specificity of this finding was 100% for talar dome viability. Avascular necrosis developed in 43% of patients, with 33% revascularizing and none going on to collapse. Subtalar arthrosis developed in 62% of patients. Screws placed from posterior to anterior are a useful technique in the treatment of talar neck fractures. Functional outcomes following their use appear favorable compared with recent reports with minimal risk to local structures. Level IV, retrospective case series.

Combined medial and lateral incisions for treatment of talar neck fracture with talar dislocation

Objective To investigate the effect of treatment of talar neck fractures with talar dislocation via medial and lateral incisions. Methods Between January 2010 and January 2013, 12 cases of talar neck fracture with talar dislocation were operated on via medial and lateral incisions. There were 10 males and 2 females with mean age of 32.5 years (range, 25-42 years). According to the modified Hawkins classification, there were 9 cases of type Ⅱ and 3 type Ⅲ. Seven cases of simple fracture (type Ⅱ) underwent open reduction and screw internal fixation. And five cases of comminuted fracture comprising 2 type Ⅱ and 3 type Ⅲ underwent internal fixation with mini-plates and screws. American Orthopedic Foot and Ankle Society (AOFAS) score was used for evaluation of ankle and hindfoot disorders. Results Ten patients were followed up for mean 30 months (range, 18-48 months). No wound healing problems or infections were seen. Mean postoperative AOFAS score was (78.5±8.9)points (range, 66-90 points). Mean time to fracture healing was 12.5 weeks (range, 10-16 weeks). Talar avascular necrosis was documented in 3 cases of comminuted fracture (1 type Ⅱ and 2 type Ⅲ), but none of them had collapse of the talar body. Two cases experienced the relieve of osteonecrosis 3 months after conservative therapy by decreasing activity and weight-bearing and one case underwent subtalar arthrodesis because of posttraumatic arthritis. Conclusion Combined medial and lateral incisions attains good results in treatment of talar neck fractures with talar dislocation. Key words: Talus; Dislocations; Fracture fixation, internal

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. Twenty-eight patients were followed up for an average of 25months (range 18-50months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14weeks (range 12-24weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85). Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.

Management of Talar Neck Fractures

Talar neck fractures are usually the result of high-energy trauma. It remains controversial whether talar neck fractures require emergent treatment. Most surgeons recommend the use of dual surgical approaches, anteromedial and anterolateral, to allow accurate visualization and anatomic reduction. It is important to carefully preserve any remaining talar blood supply. Obtaining satisfactory clinical results, while avoiding complications, presents a unique challenge in the treatment of talar neck fractures. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.

Surgical treatment of talar neck fractures with Acutrak screws

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

Results of the Treatment of Talar Neck Fractures in a West African Hospital

Talar neck fractures (TNFs) are complex injuries and treatment is fraught with complications. We retrospectively studied 18 patients with TNFs: 6 Hawkins type-I, 7 type-II, 4 type-III, and 1 type-IV. Five patients with type-I and 2 with type-II fractures were treated conservatively. The remaining 11 patients underwent operative treatment. Open reduction via posterolateral approach was performed in 10 patients while closed reduction was used in one patient. All operatively reduced fractures were stabilized with screws. The following postoperative complications were encountered: wound dehiscence (n=1), avascular necrosis (n=2), and post-traumatic osteoarthritis (n=12). Fifteen patients were available for final evaluation at a mean followup period of three years (range 10 months to 6 years). Using the American Orthopaedic Foot and Ankle Society (AOFAS) score, the mean for type-I fracture was 96.4 points, 80.2 points for type-II, 68.5 points for type-III and 55 points for type-IV fractures. TNFs remain a devastating injury as the prognosis and outcomes of treatment continued to be hampered by the consequences of injury.

Treatment of talar neck fractures with external fixators combined with vascularized bone graft

目的 探讨外固定支架联合带血管骨瓣植骨治疗距骨颈骨折的疗效.方法回顾性分析2004年1月～2005年3月收治的7例距骨颈骨折患者,按Hawkins分型:Ⅱ型6例,Ⅲ型1例,分别采用手法闭合复位(1例)和切开复位(6例)经皮空心螺钉内固定治疗,7例患者均在上述处理后加外固定支架跨关节固定联合带血管的骨瓣植骨治疗.术后观察骨愈合、骨坏死及后足功能情况.结果7例患者均获得随访,随访13～24个月,平均17个月.7例均获骨性愈合,无一例发生缺血性骨坏死.后足功能按Maryland评分系统进行评估,结果:优5例,良2例.1例合并距骨体骨折患者出现明显的胫距关节骨关节炎,最后行胫距关节融合术.结论外固定支架联合带血管骨瓣植骨能有效地防止距骨颈骨折后缺血性骨坏死,但远期效果尚须进一步观察。

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.

Surgical Treatment of Talar Neck Fractures

Consideration of gravity of talar neck fractures and evaluation of the treatment results. 22 patients suffering from talar neck fractures were retrospectively reviewed. There were ten type A, six type B, three type C, and three type D fractures according to the Hawkins classification modified by Canale & Kelly. All patients underwent open reduction and internal fixation. Excellent clinical results were observed in 45.4%, good in 27.2%, fair in 18.1%, and poor in 9.1% of the patients according to the Iowa Ankle Evaluation score. Two patients developed avascular necrosis (AVN) with body collapse, and tibiotalar fusion was required. Furthermore, five patients developed symptomatic subtalar arthritis but did not require subtalar fusion. Accurate early open reduction is considered the treatment of choice for such types of fractures. AVN is associated with late management, while subtalar arthritis does not necessarily lead to subtalar fusion.

Treatment of talar neck fractures: Clinical results of 50 patients

Fractures of the neck and body of the talus present as one of the most challenging and rare injuries. These fractures are often associated with other ankle, foot, and skeletal injuries, which complicate their treatment. The clinical course of 50 patients with a mean age of 29 years with a severe talus fracture between 1992 and 1997 is presented. According to the Hawkins classification there were 16 (32%) of type I, 14 (28%) of type II, 9 (18%) of type III, and 11 (22%) of type IV. Forty-three patients (86%) underwent operative treatment: 27 (63%) by open reduction and internal fixation with screws, seven (16%) by external fixation, five (12%) with percutaneous screws, and four (9%) by closed reduction with K-wire fixation. Mild osteoarthritis of the talocrural joint was seen in 14 patients (28%) and severe osteoarthritis in 10 patients (20%), five of whom required subsequent arthrodesis of the ankle joint. Arthrodesis of the subtalar joint was observed in 4 cases. Avascular necrosis with collapse of the talar body was seen in four patients (8%). The function of the ankle joint was evaluated according to the Weber score. Patients with talus fractures of Hawkins' type I and II had considerably better outcomes (with 95% being excellent or good) than individuals suffering dislocated fractures with involvement of the articulating surface with 70% good results in Hawkins' type III and 10% good results in Hawkins' type IV fractures. For the evaluation of the vitality of the talus body in cases with titanium implants, the authors used magnetic resonance imaging and intraosseous phlebography in cases with stainless steel implants. The displaced talus fractures must be treated by closed and, if necessary, open reduction with internal fixation. The initial postoperative management should consist of ambulation without weightbearing until radiographic appearance of trabecular bone in the fracture zone, indicating revascularization, can be manifested.