Lindvall, J Bone Joint Surg Am 2004 - Open Reduction and Stable Fixation of Isolated, Displaced Talar Neck and Body Fractures

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Open Reduction and Stable Fixation of Isolated, Displaced Talar Neck and Body Fractures

Lindvall, Sanders, et al.·J Bone Joint Surg Am·2004·284 citations·Retrospective cohort

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Background

The purpose of this retrospective review was to evaluate the long-term results of surgical treatment of isolated, displaced talar neck and/or body fractures with stable internal fixation.

Methods

The study included 25 patients with a total of 26 displaced fractures isolated to the talus that had been treated with open reduction and stable internal fixation and followed for a minimum of 48 months after the injury.
The final follow-up examination included standard radiographs, computed tomography, and a clinical evaluation.
Variables that were analyzed included wound type, fracture type, Hawkins type, comminution, timing of the surgical intervention, surgical approach, quality of fracture reduction, Hawkins sign, osteonecrosis, union, time to union, posttraumatic arthritis, and the AOFAS scores including subscores (pain, function, and alignment).

Results

The average duration of follow-up was 74 months.
Surgical intervention resulted in 16 fractures with an anatomic reduction, 5 with a nearly anatomic reduction, and 5 with a poor reduction.
All 8 noncomminuted fractures were anatomically reduced.
The overall union rate was 88%.
All closed, displaced talar neck fractures healed, regardless of the time delay until surgical intervention.
Posttraumatic arthritis of the subtalar joint was the most common finding and was seen in all patients, 16 of whom had involvement of more than one joint.
Osteonecrosis was a common finding, seen after 13 of the 26 fractures overall and after 6 of the 7 open fractures.

Conclusions

Open reduction and internal fixation is recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Patients with a displaced fracture of the talus should be counseled that posttraumatic arthritis and chronic pain are expected outcomes even after anatomic reduction and stable fixation. This is especially true following open fractures.

Copyright remains with the authors and publisher.

Open Reduction and Stable Fixation of Isolated, Displaced Talar Neck and Body Fractures.

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Open Reduction and Stable Fixation of Isolated, Displaced Talar Neck and Body Fractures

Lindvall, Sanders, et al.·J Bone Joint Surg Am·2004·284 citations·Retrospective cohort

|

Background

The purpose of this retrospective review was to evaluate the long-term results of surgical treatment of isolated, displaced talar neck and/or body fractures with stable internal fixation.

Methods

The study included 25 patients with a total of 26 displaced fractures isolated to the talus that had been treated with open reduction and stable internal fixation and followed for a minimum of 48 months after the injury.
The final follow-up examination included standard radiographs, computed tomography, and a clinical evaluation.
Variables that were analyzed included wound type, fracture type, Hawkins type, comminution, timing of the surgical intervention, surgical approach, quality of fracture reduction, Hawkins sign, osteonecrosis, union, time to union, posttraumatic arthritis, and the AOFAS scores including subscores (pain, function, and alignment).

Results

The average duration of follow-up was 74 months.
Surgical intervention resulted in 16 fractures with an anatomic reduction, 5 with a nearly anatomic reduction, and 5 with a poor reduction.
All 8 noncomminuted fractures were anatomically reduced.
The overall union rate was 88%.
All closed, displaced talar neck fractures healed, regardless of the time delay until surgical intervention.
Posttraumatic arthritis of the subtalar joint was the most common finding and was seen in all patients, 16 of whom had involvement of more than one joint.
Osteonecrosis was a common finding, seen after 13 of the 26 fractures overall and after 6 of the 7 open fractures.

Conclusions

Open reduction and internal fixation is recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Patients with a displaced fracture of the talus should be counseled that posttraumatic arthritis and chronic pain are expected outcomes even after anatomic reduction and stable fixation. This is especially true following open fractures.

Copyright remains with the authors and publisher.

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