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Considerable controversy surrounds the management of talar neck fractures regarding the rate of post-traumatic arthrosis, secondary procedures, avascular necrosis, and the effect of the interval to surgery on these variables. A data search using PubMed was performed with the keywords "talus" and "fracture." The search found 1280 studies. Ultimately, 21 reports involving 943 talar neck fractures were analyzed. Data concerning open fractures, the interval to surgery and its relationship to the incidence of avascular necrosis, and the rates of malunion and nonunion, post-traumatic arthrosis, secondary salvage procedures, and functional outcomes were collected and analyzed. The variables examined were not uniformly reported in all studies. The overall rate of avascular necrosis was 33%, with no demonstrated relationship between the interval to surgery and the rate of avascular necrosis. Malunion occurred approximately 17% of the time, with nonunion occurring approximately 5% of the time. Post-traumatic arthrosis occurred in 68% of patients, although secondary salvage procedures were only performed in 19% of patients. Functional outcomes were difficult to assess, given the variability of reported outcomes and unvalidated measures. The optimal management of talar neck fractures has yet to be determined. Although the present review has improved understanding of these difficult fractures, additional studies that use validated outcomes measures are warranted to determine the effect of delayed surgery on final outcomes and optimal treatment methods.
Functional and radiological outcomes of operative management of displaced talar neck fractures.
Rajendra Annappa, Nand Lal Jhamaria, K.V.N. Dinesh, Devkant, Raghu H. Ramesh, Pooja K. Suresh The Foot; Article in Press
•we studied results of operative management of talar neck fractures first time in india.
•early fixation had good results.
•higher the grade of injuries worse the results.
•in grade 3 and grade 4 injuries modified arthrodesis can be considered as an alternative to fixation
To evaluate functional and radiological results of internal fixation of displaced talar neck fractures.
Materials and methods
Twenty patients with displaced talar neck fractures who underwent surgery and fixation by cancellous screws were evaluated. Patients were evaluated by American Orthopaedic Foot and Ankle Society score which is based on pain (40 points), function (50 points) and alignment (10 points) with excellent (90-100 points), good (75-89 points), fair (60-74 points) and poor scores (<60 points) and radiographically for assessment of union, osteonecrosis and osteoarthritic changes in the subtalar and ankle joint.
Among the 20 cases, 13 cases had closed injuries and 7 had open fractures. The most common etiology of injury was road traffic accidents. The average follow up time was 28 months. Osteonecrosis was evident on follow up x-rays in 7 cases of which 2 progressed to talar dome collapse. Post traumatic arthritis was observed in 11 cases. Based on American Orthopaedic Foot and Ankle Society scores, excellent result was obtained in 4 cases, good 7 cases, fair 5 cases and poor 4 cases.
Talar neck fractures are associated with high rates of morbidity and complications. Post traumatic arthritis is more common complication than osteonecrosis following surgery.
INTRODUCTION: Talar neck fractures occur as the result of high-energy trauma. In addition to the initial
soft tissue damage, numerous long-term sequelae (post-traumatic arthritis, malunion, avascular
necrosis, etc.) can develop which make talar neck fractures devastating injuries. While proposed
mechanisms of injury exist, it has not been established if there are anatomic predispositions to
developing fractures of the talar neck.
METHODS: In this retrospective study, patients treated for talar neck fractures from 2001 to 2011 were
identified at two institutions. In 57 patients with talar neck fractures, the weight-bearing lateral
radiographs of the normal, uninjured limb were obtained. Talo-first metatarsal angle, talocalcaneal
angle, and calcaneal pitch angle were examined to determine if patients with talar neck fractures had
morphologic differences from the general population.
RESULTS: In comparison with historical values of the neutral foot, patients who sustained talar neck
fractures were found to have a higher talo-first metatarsal angle, lower talocalcaneal angle, and higher
calcaneal pitch angle.
CONCLUSIONS: The development of a talar neck fracture was shown to be associated with a pes cavus
foot morphology as 64.9% of patients exhibited some degree of pes cavus.