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Kopp L, Rammelt S. Posttraumatic Avascular Necrosis of the Talus: Prevention, Course, and Treatment Options. Foot Ankle Clin 2025; 30:83-110. [PMID: 39894621 DOI: 10.1016/j.fcl.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Avascular necrosis (AVN) of the talus in a posttraumatic setting describes a condition of temporary or permanent bone death of a different extent, initiated by a circulatory disturbance. It is estimated that about 75% of all talar AVNs are caused by a prior trauma. The incidence of posttraumatic AVN rises with higher energy of injury, severity of talar body or neck displacement, fracture comminution, and injury to the soft tissues and major vessels in the lower leg and ankle region. These conditions are often seen in open fractures, fracture dislocations, and pure dislocations.
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Affiliation(s)
- Lubomir Kopp
- Clinic of Trauma Surgery, "Masaryk" Hospital, Purkinje University, Usti nad Labem, Czechia; 2nd Faculty of Medicine, Department of Anatomy, Charles University, Prague, Czechia.
| | - Stefan Rammelt
- University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital "Carl Gustav Carus", Fetscherstraße 74, 01307 Dresden, Germany
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Dell’Agli E, Sapienza M, Castiglione MD, Musumeci MA, Pitronaci S, Sodano A, Pavone V, Testa G. Pantalar Intact Dislocation: A Systematic Review. J Funct Morphol Kinesiol 2025; 10:55. [PMID: 39982295 PMCID: PMC11843910 DOI: 10.3390/jfmk10010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/24/2025] [Accepted: 01/30/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND This scoping review analyzes the available literature on pure total talar dislocation, focusing on its epidemiology, clinical presentation, imaging techniques, surgical options, rehabilitation protocols, and complications. METHODS Following the PRISMA-ScR guidelines, a comprehensive search was conducted across the PubMed, Web of Science, and Scopus databases. The search yielded 185 articles, of which 30 satisfied the inclusion criteria and focused on pure total talar dislocation without fractures. Data from each study were extracted, including patient demographics, injury characteristics, treatment methods, and outcomes. RESULTS The studies included case reports, case series, and reviews. Despite the heterogeneity of the studies, the key findings suggest that early reduction, careful wound management, and soft tissue preservation are crucial in minimizing complications such as avascular necrosis (AVN), post-traumatic arthritis, and infection. The long-term outcomes varied, and the risk of AVN remained high, particularly in cases with compromised blood supply to the talus. CONCLUSIONS Pure total talar dislocation is a rare and challenging condition with no established management protocol. While talar reimplantation and joint fixation offer promising outcomes in preserving function, the risk of complications, particularly AVN, remains significant. Additional research is necessary to standardize treatment protocols and improve clinical outcomes for this rare but severe injury.
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Affiliation(s)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, A.O.U. Policlinico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; (E.D.); (M.D.C.); (M.A.M.); (S.P.); (A.S.); (V.P.); (G.T.)
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Aslan L, Ghandour S, Ashkani-Esfahani S, Gedik CC, Guss D, Waryasz G, Bejarano-Pineda L, DiGiovanni CW, Kwon JY. Association of Extraosseous Arterial Diameter With Talar Dome Osteochondral Lesions. Foot Ankle Int 2024; 45:1199-1209. [PMID: 39412746 DOI: 10.1177/10711007241278672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
BACKGROUND Etiology of osteochondral lesions of the talus (OLT) is multifactorial and may develop from trauma, genetics, or hypovascularity. The talar dome is supplied by the posterior tibial artery (PTA) and, to a lesser degree, the sinus tarsi artery (STA). The role of talar dome hypovascularity on OLT remains poorly studied. We aimed to determine any relationship between the diameter of PTA (dPTA) and STA (dSTA) and the incidence and characteristics of talus OLT. METHODS This retrospective study included 77 patients with OLT and 77 subjects as a matched control group (age range: 30-40 years). Using magnetic resonance imaging, the dPTA was measured 1 cm above the tibial plafond, at the plafond, and at the level of medial malleolar tip. Likewise, dSTA was measured at the level of the talar neck. The area, volume, depth, localization, and surgical intervention for OLT were recorded as well. RESULTS The study group had significantly smaller dPTA at all 3 levels (1.05 ± 0.22 mm, 0.99 ± 0.18 mm, 0.98 ± 0.31 mm, proximal to distal, respectively) compared with controls (1.25 ± 0.23 mm, 1.20 ± 0.22 mm, 1.14 ± 0.18 mm, respectively) (P < .001). The dSTA was also significantly smaller in the study group compared with the control group (0.5 ± 0.11 mm vs 0.57 ± 0.08 mm, respectively; P = .001). The mean dPTA (of all 3 levels) cutoff value for predicting the occurrence of OLT was 1.1 mm with 74% sensitivity and 75% specificity. A significant inverse correlation was observed between OLT area and arterial diameters (P < .001). CONCLUSION Smaller luminal dPTA and dSTA appear to be associated with higher incidence of OLT, with defect size inversely correlated to arterial diameter.
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Affiliation(s)
- Lercan Aslan
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Samir Ghandour
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Daniel Guss
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John Y Kwon
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kubisa MJ, Kubisa MG, Pałka K, Sobczyk J, Bubieńczyk F, Łęgosz P. Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1692. [PMID: 39459479 PMCID: PMC11509827 DOI: 10.3390/medicina60101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/17/2024] [Accepted: 09/22/2024] [Indexed: 10/28/2024]
Abstract
Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I-II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III-IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR.
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Affiliation(s)
- Michał Jan Kubisa
- Orthopedic and Traumatology Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (M.J.K.)
| | - Marta Gabriela Kubisa
- Orthopedic and Sport Traumatology Department, Carolina Medical Center, 02-757 Warszawa, Poland;
| | - Karol Pałka
- Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jakub Sobczyk
- Orthopedic and Sport Traumatology Department, Carolina Medical Center, 02-757 Warszawa, Poland;
| | - Filip Bubieńczyk
- Orthopedic and Traumatology Department, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Paweł Łęgosz
- Orthopedic and Traumatology Department, Medical University of Warsaw, 02-091 Warszawa, Poland; (M.J.K.)
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Griffin JT, Landy DC, Mechas CA, Nazal MR, Foster JA, Moghadamian ES, Srinath A, Aneja A. The Hawkins Sign of the Talus: The Impact of Patient Factors on Prediction Accuracy. J Bone Joint Surg Am 2024; 106:958-965. [PMID: 38512980 DOI: 10.2106/jbjs.23.00906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Osteonecrosis is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. The Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is a strong predictor of preserved talar vascularity. This study sought to assess the accuracy of the Hawkins sign in a contemporary cohort and assess factors associated with inaccuracy. METHODS A retrospective review of talar neck fractures at a level-I trauma center from 2008 to 2016 was conducted. Both the Hawkins sign and osteonecrosis were evaluated on radiographs. The Hawkins sign was determined on the basis of radiographs taken approximately 6 to 8 weeks after injury, whereas osteonecrosis was determined based on radiographs taken throughout follow-up. The Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (CIs), and associations were examined with Fisher exact testing. RESULTS In total, 105 talar neck fractures were identified. The Hawkins sign was observed in 21 tali, 3 (14% [95% CI, 3% to 36%]) of which later developed osteonecrosis. In the remaining 84 tali without a Hawkins sign, 32 (38% [95% CI, 28% to 49%]) developed osteonecrosis. Of the 3 tali that developed osteonecrosis following observation of the Hawkins sign, all were in patients who smoked. CONCLUSIONS A positive Hawkins sign may not be a reliable predictor of preserved talar vascularity in all patients. We identified 3 patients with a positive Hawkins sign who developed osteonecrosis, all of whom were smokers. Factors impairing the restoration of microvascular blood supply to the talus may lead to osteonecrosis despite the presence of preserved macrovascular blood flow and an observed Hawkins sign. Further research is needed to understand the factors limiting Hawkins sign accuracy. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarod T Griffin
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Charles A Mechas
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Mark R Nazal
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Jeffrey A Foster
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric S Moghadamian
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Arjun Srinath
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Arun Aneja
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
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Huang X, Ruan S, Lei Z, Cao H. Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study. J Orthop Surg Res 2023; 18:765. [PMID: 37817154 PMCID: PMC10566102 DOI: 10.1186/s13018-023-04253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children. METHODS A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain. RESULTS All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively. CONCLUSION The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.
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Affiliation(s)
- Xincheng Huang
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Siyuan Ruan
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Zhuolin Lei
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China
| | - Hong Cao
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, People's Republic of China.
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Hegazy MA, Khairy HM, Hegazy AA, Sebaei MAEF, Sadek SI. Talus bone: normal anatomy, anatomical variations and clinical correlations. Anat Sci Int 2023; 98:391-406. [PMID: 37017903 DOI: 10.1007/s12565-023-00712-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/28/2023] [Indexed: 04/06/2023]
Abstract
Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.
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Affiliation(s)
| | - Hossam Mohammed Khairy
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
| | - Abdelmonem Awad Hegazy
- Basic Medical Science Department, Faculty of Dentistry, Zarqa University, Zarqa City, 13110, Jordan.
- Human Anatomy and Embryology Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt.
| | | | - Sami Ibrahim Sadek
- Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Zagazig City, 44519, Egypt
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Parmeshwar SS, Sharma SL, Sharma A, Shetty A, B M K, Patil S. A comparative study of three different approaches in treatment of talar neck fractures. J Clin Orthop Trauma 2023; 37:102092. [PMID: 36711112 PMCID: PMC9875720 DOI: 10.1016/j.jcot.2022.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/30/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Purpose The 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 method A 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). Results 30 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. Conclusion There 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.
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Affiliation(s)
| | - Shyoji Lal Sharma
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Arun Sharma
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Abhijit Shetty
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Kiran B M
- Department of Orthopaedics, Grant Medical College, Mumbai, India
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A retrospective analysis of the definitive management of open talus fractures at a major trauma centre, comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:393-400. [PMID: 35031854 PMCID: PMC8759602 DOI: 10.1007/s00590-022-03204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion. METHODS A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM. RESULTS Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. CONCLUSION FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.
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Talar neck and body fracture outcomes: a multicentre retrospective review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:99-105. [PMID: 34807327 DOI: 10.1007/s00590-021-03161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/01/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Talar neck and body fractures are uncommon injuries that are challenging to manage with high reported complication rates, including post-traumatic arthritis, avascular necrosis, and poor functional outcomes. The aim of this study was to assess the complication rates for patients with talus fractures across three major trauma centres (MTCs) in England. METHODS A retrospective analysis was performed of prospectively collected trauma databases. Data were collected from three English MTCs. Patients with talar neck and/or body fractures sustained between August 2015 and August 2019 were identified and their clinical course reviewed radiologically and clinically. Isolated process fractures, osteochondral defects and paediatric patients were excluded. Patients were analysed by fracture type and for definitive treatment method with separation into non-operative and operative management groups. Procedure type was identified in the operative group. Superficial infection, deep infection, non-union, avascular necrosis, post-traumatic arthritis and removal of metalwork rates were analysed. RESULTS Eighty-five patients with talar neck and/or body fractures were included. Seventy-five patients received operative management, 10 non-operative. The overall AVN rate was 5.9% (five patients), overall post-traumatic arthritis rate was 18.8% (16 patients), deep infection rate 1.2% (one patient), non-union rate 4.7% (four patients). Removal of metalwork rate was 9.4% (eight patients). CONCLUSION Our reported outcomes and complication rates are generally lower than those previously described. This may be a result of improved techniques, a higher frequency of open reduction with direct visualisation or by surgery occurring in centralised specialist centres.
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Presurgical Perspective and Postsurgical Evaluation of Calcaneal and Talus Fractures. Semin Musculoskelet Radiol 2022; 26:635-643. [PMID: 36791733 DOI: 10.1055/s-0042-1760119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Fractures of the calcaneus and talus are severe injuries that usually result from high-energy trauma. The calcaneus and talus are essential for the transmission of body weight, so an optimal reduction and/or fixation of fractures is required to prevent disabling consequences. These fractures almost always have an articular involvement, and an anatomical reduction is required; any residual step-off would lead to joint incongruity and secondary arthrosis.The aims of imaging are first, to guide management by describing the fracture characteristics (e.g., location, displacement, fragments, articular involvement, soft tissue compromise), and second, to detect early and late surgical complications (e.g., infection, malunion, nonunion, arthrosis, hardware issues). Although radiographs remain the first-line imaging modality for the screening of ankle and foot trauma, computed tomography is almost always required for the initial management and follow-up of the patient.
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Wijers O, Posthuma JJ, Engelmann EWM, Schepers T. Complications and Functional Outcome Following Operative Treatment of Talus Neck and Body Fractures: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127201. [PMID: 36199382 PMCID: PMC9528034 DOI: 10.1177/24730114221127201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures, complications rates remain high and functional outcome is generally poor. This study aims to provide an overview of complication rates and functional outcome following operative treatment of talar neck and body fractures. This may help in clinical decision making by improving patients’ expectation management and tailored treatment strategies. Methods: A systematic review of the literature was conducted of studies published from January 2000 to July 2021 reporting functional outcome and/or complications following operative treatment of talar neck, body, or combined neck and body fractures. Keywords used were (Talar fracture) or (Talus fracture). Data on complication rates and functional outcome was extracted from selected articles. Results: A total of 28 articles were included in our analysis reporting 1086 operative treated talar fractures (755 neck [70%], 227 body fractures [21%], and 104 combined body and neck fractures [9%]). The mean follow-up was 48 (range 4-192) months. Complications occurred frequently with; 6% surgical site infection, 8% nonunion, 29% avascular necrosis, 64% osteoarthritis, and in 16% a secondary arthrodesis was necessary. A wide variety in functional outcome was reported; however, there seems to be a correlation between fracture classification and postoperative complications. Conclusion: Operative treatment of central talar fractures is associated with a high incidence of early and late complications and often leads to an impaired functional outcome. Standardization of talar fracture classification and scoring systems in combination with large sample-sized prospective studies are warranted to detect further predictive factors influencing tailormade treatment strategies and patient expectation management. Level of Evidence: Level III, Systematic review of case series and case-control studies.
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Affiliation(s)
- Olivier Wijers
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Jelle J. Posthuma
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Esmee W. M. Engelmann
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Traumasurgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
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13
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Closed reduction and posterior percutaneous internal fixation for simple displaced talar neck fracture: a retrospective comparative study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2135-2143. [DOI: 10.1007/s00264-022-05432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
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14
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Smitaman EE, Davis M. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. Radiographics 2022; 42:661-682. [PMID: 35275783 DOI: 10.1148/rg.210167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hindfoot consists of the talus and calcaneus, spans the tibiotalar to transverse tarsal joints, and is critical for support of body weight and absorption and transfer of physiologic loads during bipedal movements. Hindfoot fractures account for approximately 17% of foot and ankle fractures, with calcaneal fractures being more common than talar fractures. Hindfoot fractures are usually caused by high-impact axial loads such as falls from heights and motor vehicle accidents, and understandably, they are often seen in patients with polytrauma. Long term, these fractures have implications in development of posttraumatic osteoarthrosis with associated pain and stiffness, affecting daily living activities. An overview of the talus and calcaneus is presented, with emphasis on fractures with articular involvement-namely, the tibiotalar and subtalar joints. Articular talar and calcaneal injuries can also alter hindfoot alignment, causing ankle and foot function abnormalities. Optimal treatment-that is, restoration of articular surfaces and hindfoot alignment followed by rigid fixation until fracture union-is dependent on an accurate understanding of the injury that is well depicted with imaging, radiography and CT in particular. The discussion of talar and calcaneal fractures includes a review of the normal anatomy, epidemiologic factors, classification systems, and imaging and pathologic-anatomic features of common injury patterns. This review is intended to aid surgical management and restoration of articular and hindfoot alignment for optimal ankle and foot function, thereby reducing patient morbidity in these often devastating injuries. ©RSNA, 2022.
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Affiliation(s)
- Edward Eddie Smitaman
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
| | - Michael Davis
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
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15
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Closed Pantalar Dislocation With Checkrein Deformity: A Unique Case Report and Literature Review. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202110000-00013. [PMID: 34678856 PMCID: PMC8542153 DOI: 10.5435/jaaosglobal-d-20-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/08/2021] [Indexed: 11/18/2022]
Abstract
Closed pantalar dislocations are a rare variant of an uncommon injury. Pantalar dislocations are typically caused by high-energy trauma resulting in an open injury with associated fracture of the articulating bones. Given its obscurity, the literature on closed pantalar dislocations is scarce, and no standard treatment protocol has been accepted. This case report chronicles the treatment and outcome of a 29-year-old man who presented with a checkrein deformity of all digits after a closed pantalar dislocation with 6-month follow-up. A comprehensive literature review found 28 articles representing 39 patients with closed pantalar dislocations without talar neck or body fractures. Roughly equal numbers of closed and open reduction techniques were performed with avascular necrosis occurring in 7 of 36 patients. Although outcome measures and follow-up were variable, what can be considered a suitable outcome was seen in approximately 83% of patients, with only 3 of 35 requiring a secondary operation. Long-term studies with well-defined outcome measures are needed to adequately predict the prognosis of this rare injury and efficacy of treatment protocols.
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16
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Abstract
The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.
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17
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Issaoui H, Fekhaoui MR, Abbassi H, Gargouri M, Ali M. Outcomes of a Reimplanted Talus After a Total Open Extrusion. Cureus 2020; 12:e9678. [PMID: 32802625 PMCID: PMC7425830 DOI: 10.7759/cureus.9678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Total traumatic extrusion of the talus is a severe and disabling ankle injury that requires a high energy trauma. Many treatment options exist and none of them guarantee a successful result. Here, we present the case of a 67-year-old woman who experienced an open total traumatic extrusion of the talus. Based on the principles of open fracture management, we have realized an early administration of antibiotics and tetanus toxoid booster followed by an urgent debridement of the wound. Next, the talus was reimplanted and fixed with a K-wire. This allowed us to avoid the common complication and achieving good clinical outcomes. In our opinion, this is an encouraging and reasonable treatment option unless the talus is grossly contaminated or missing.
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Affiliation(s)
- Hichem Issaoui
- Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, FRA
| | - Mohammed-Reda Fekhaoui
- Department of Trauma and Orthopedic Surgery, Ibn Sina University Hospital, Faculty of Medicine, Mohammed V University of Rabat, Rabat, MAR.,Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, FRA
| | - Hatem Abbassi
- Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, FRA
| | - Mahdi Gargouri
- Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, FRA
| | - Mazen Ali
- Department of Orthopedic Surgery and Trauma, Regional Hospital Center of Orleans, Orleans, FRA
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18
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AlMaeen BN, ElMaghrby IS, AlNour MK, Alrefeidi TA, Abu Adas SM. Complete Revascularization of Reimplanted Talus After Isolated Total Talar Extrusion: A Case Report. Cureus 2020; 12:e7947. [PMID: 32377500 PMCID: PMC7199902 DOI: 10.7759/cureus.7947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.
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Affiliation(s)
- Bandar N AlMaeen
- Surgery/Orthopedic Surgery, College of Medicine, Jouf University, Al-Jouf, SAU
| | | | | | - Tareq A Alrefeidi
- Orthopedic Surgery, Armed Forces Hospital Southern Region, Khamis Mushyt, SAU
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19
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Alshryda S, Alfuqaha H, Elgabaly EA, Aldlyami E. Moon (or Eid) Crescent Sign of the Femoral Head. Cureus 2020; 12:e6867. [PMID: 32181099 PMCID: PMC7053701 DOI: 10.7759/cureus.6867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Avascular necrosis (AVN) of the femoral head following slipped capital femoral epiphysis (SCFE) is a serious complication that often leads to a permanent disability. Radiological findings of AVN may take up to two years to become apparent. This means painful waiting for children, parents, and treating teams. We would like to describe a new radiological sign that we noted in four patients. The sign has been named as the crescent moon sign or eid crescent sign. It may become visible as early as six weeks following surgery, and it carries a good prognosis that the femoral head is viable and will not develop AVN. Two out of the four patients were treated in our hospital by Ganz surgical dislocation. The other two patients had been featured in other publications, but the significance of the moon crescent signs, which were present, was not recognized or appreciated. All four patients did not develop AVN. A relatively similar radiological sign has been described in talus bone fractures (Hawkins' sign). Like SCFE, talus bone fractures have a high AVN rate. Both, the crescent moon sign and Hawkins' sign carry a good prognosis and indicate that the bone blood supply is restored.
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Affiliation(s)
- Sattar Alshryda
- Pediatric Orthopaedics and Trauma, Al Jalila Children's Speciality Hospital, Dubai, ARE
| | | | - Elham A Elgabaly
- Pediatric Radiology, Al Jalila Children Specialty Hospital, Dubai, ARE
| | - Ehab Aldlyami
- Trauma and Orthopaedics, Medcare Orthopaedics and Spine Hospital, Dubai, ARE
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20
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Posttraumatic Avascular Necrosis After Proximal Femur, Proximal Humerus, Talar Neck, and Scaphoid Fractures. J Am Acad Orthop Surg 2019; 27:794-805. [PMID: 31149969 DOI: 10.5435/jaaos-d-18-00225] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Posttraumatic avascular necrosis (AVN) is osteonecrosis from vascular disruption, commonly encountered after fractures of the femoral neck, proximal humerus, talar neck, and scaphoid. These locations have a tenuous vascular supply; the diagnosis, risk factors, natural history, and treatment are reviewed. Fracture nonunion only correlates with AVN in the scaphoid. In the femoral head, the risk is increased for displaced fractures, but the time to surgery and open versus closed treatment do not seem to influence the risk. Patients with collapse are frequently symptomatic, and total hip arthroplasty is the most reliable treatment. In the humeral head, certain fracture patterns correlate with avascularity at the time of injury, but most do not go on to develop AVN due to head revascularization. Additionally, newer surgical approaches and improved construct stability appear to lessen the risk of AVN. The likelihood of AVN of the talar body rises with increased severity of talar injury. The development of AVN corresponds with a worse prognosis and increases the likelihood of secondary procedures. In proximal pole scaphoid fractures, delays in diagnosis and treatment elevate the risk of AVN, which is often seen in cases of nonunion. The need for vascularized versus nonvascularized bone grafting when repairing scaphoid nonunions with AVN remains unclear.
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21
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Biz C, Golin N, De Cicco M, Maschio N, Fantoni I, Frizziero A, Belluzzi E, Ruggieri P. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management. BMC Musculoskelet Disord 2019; 20:363. [PMID: 31391024 PMCID: PMC6686493 DOI: 10.1186/s12891-019-2738-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management. METHODS From January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed. RESULTS 27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49-119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7-7). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0-11 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9-10). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%). CONCLUSIONS Despite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF.
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Affiliation(s)
- Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Nicolò Golin
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Michele De Cicco
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Nicola Maschio
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
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22
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Yapici F, Coskun M, Arslan MC, Ulu E, Akman YE. Open reduction of a total talar dislocation: A case report and review of the literature. World J Clin Cases 2019; 7:1850-1856. [PMID: 31417931 PMCID: PMC6692273 DOI: 10.12998/wjcc.v7.i14.1850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Total talar dislocation (TTD) is very uncommon for many orthopedic surgeons and emergency/trauma specialists. Scarce cases of TTD have been reported, mainly in the form of open fracture-dislocation injury.
CASE SUMMARY We report a very rare injury of closed TTD with a follow-up period of 36 mo. Initial closed reduction was not successful because of a fractured highly unstable medial malleolus displaced into the ankle mortise, blocking the relocation of the talus. The patient was able to walk pain-free after the 3rd month of surgery. At the 36-mo follow-up, there were 10 degrees of flexion loss and 10 degrees of extension loss in the tibiotalar joint. Furthermore, 5 degrees of subtalar joint inversion-eversion loss was present.
CONCLUSION Open reduction should be performed for closed TTDs unless closed reduction is successful.
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Affiliation(s)
- Furkan Yapici
- Department of Orthopedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Education and Research Hospital, Istanbul 34470, Turkey
| | - Mehmet Coskun
- Department of Orthopedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Education and Research Hospital, Istanbul 34470, Turkey
| | - Muhammet Coskun Arslan
- Department of Orthopedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Education and Research Hospital, Istanbul 34470, Turkey
| | - Erman Ulu
- Department of Orthopedics and Traumatology, Metin Sabancı Baltalimanı Bone and Joint Diseases Education and Research Hospital, Istanbul 34470, Turkey
| | - Yunus Emre Akman
- Department of Orthopedics and Traumatology, Demiroğlu Bilim University Faculty of Medicine, İstanbul 34387, Turkey
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23
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[Arch-shaped approach : New modified medial approach for the treatment of talus fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:73-81. [PMID: 31270573 DOI: 10.1007/s00064-019-0617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Anatomical reduction and fixation of complex talar fractures (Hawkins type III and IV, Marti type III and IV) using a medial approach. INDICATIONS Displaced talar fractures (Hawkins type III and IV, Marti type III and IV) with the need for a medial malleolar osteotomy or the simultaneous treatment of a medial malleolus fracture. CONTRAINDICATIONS High perioperative risk, severe soft tissue injuries in the medial approach area, infected soft tissues. SURGICAL TECHNIQUE Medial arch-shaped approach about 12 cm in length over the medial malleolus using a simultaneous medial malleolus fracture or via an additional medial malleolar osteotomy. Dissection and retraction of the terminal branches of the saphenous vein and the saphenous nerve. Protection of the blood supply in the area of the medial talus and in the sinus tarsi. Reduction of the talar joint surfaces and reconstruction of the anatomical axes according to the preoperative planning by means of native radiological and computed tomographic imaging. Osteosynthesis adapted to the fracture type using Kirschner wires, conventional screws, cannulated screws, double-threaded screws, resorbable pins, magnesium screws, small fragment plates. POSTOPERATIVE MANAGEMENT Lower leg splint or orthesis for 6 weeks, partial weight-bearing with 20 kg for 10-12 weeks. Early range of motion exercise of the ankle, subtalar and mid-tarsal joints. RESULTS In the past 5 years, 11 patients with either Hawkins type III and IV or Marti type III and IV fractures were treated operatively using the arch-shaped approach. No soft tissue problems were seen related to the arch-shaped approach. Of the 7 patients who could be followed up after an average of 2 years, the mean American Orthopedic Foot and Ankle Score was 73. Avascular necrosis occurred in 3 cases (43%). These were partial necroses of less than one third of the talar body with asymptomatic course at the time of examination. In 4 patients (57%) radiographic signs of osteoarthritis occurred within 2 years, whereby in two of those cases (29%) an arthrodesis of the upper ankle was performed.
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24
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Abstract
Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation. Periosteal stripping should be limited to only that necessary to obtain anatomic reduction. Dissection within the sinus tarsi or tarsal canal should be avoided. Rigid internal fixation with solid cortical screws countersunk within the talar head and placed below the "equator" of the talar head is imperative for optimum stability.
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Affiliation(s)
- Michael P Clare
- Foot & Ankle Fellowship, Florida Orthopaedic Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA.
| | - Patrick J Maloney
- The Institute for Foot and Ankle Reconstruction at Mercy, 301 St Paul Place, Baltimore, MD 21202, USA
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25
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Flippin M, Fallat LM. Open Talar Neck Fracture With Medial Subtalar Joint Dislocation: A Case Report. J Foot Ankle Surg 2019; 58:392-397. [PMID: 30658956 DOI: 10.1053/j.jfas.2018.08.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 02/03/2023]
Abstract
We present a unique case of an open talar neck fracture with medial subtalar joint dislocation. This rare and traumatic injury was treated with immediate open reduction of the subtalar joint and open reduction internal fixation of the talar neck fracture. After a follow-up of 2.2 years, highlighted by numerous complications including posttraumatic arthritis, soft tissue abscess, and fibrotic adhesions, the patient recovered sufficiently to return full activity.
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Affiliation(s)
- Mitchell Flippin
- Podiatric Surgical Resident, Department of Podiatric Surgery, Beaumont Hospital Wayne, Wayne, MI.
| | - Lawrence M Fallat
- Podiatric Surgical Resident, Department of Podiatric Surgery, Beaumont Hospital Wayne, Wayne, MI
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26
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Abstract
Avascular necrosis (AVN) of the talus bone is a progressive and debilitating consequence of trauma or exposure to a variety of risk factors. The Ficat classification describes current understanding of the natural history of AVN, including preclinical, preradiographic, precollapse, postcollapse, and arthritic stages. The size and location of the avascular region likely determines risk of progression; however, symptoms do not correlate with stage. Patients may be minimally symptomatic despite diffuse involvement for long periods. Joint-sparing strategies have shown promise but do not universally prevent progression of the disease. When bone structure fails, joint-sacrificing strategies may be required.
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Affiliation(s)
- Andrew Haskell
- Departments of Orthopedic Surgery and Sports Medicine, Palo Alto Medical Foundation, 301 Industrial Road, San Carlos, CA 94070, USA.
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27
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Abstract
PURPOSE OF THE REVIEW Talar neck fractures are a rare but potentially devastating injury, which require a comprehensive understanding of the unique osteology, vasculature, and surrounding anatomy to recognize pathology and treat correctly. The purpose of this article is to describe both classic and current literature to better understand the evolution of talar neck fracture management. RECENT FINDINGS Urgent reduction of displaced fractures and dislocations remains the standard of care to protect the soft tissue envelope and neurovascular structures. Delayed definitive fixation has proven to be safe. CT is the imaging modality of choice to fully identify the fracture pattern and associated injuries. Anatomic reduction and restoration of the peritalar articular surfaces are the pillars of talar neck fracture treatment. Dual incision approach with plate and screw fixation has become the modern surgical strategy of choice to accomplish these goals. Although complications such as osteonecrosis (ON) and posttraumatic arthritis (PTA) can still occur at high rates, treatment should be dictated by patient symptoms. Talar neck fractures pose treatment challenges with both initial injury and potential sequelae. Future research will determine whether modern treatment algorithms will decrease complication rate and improve patient outcome.
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Affiliation(s)
- Colin Whitaker
- Department of Orthopedic Surgery, Einstein Healthcare Network, 5501 Old York Road, WCB4, Philadelphia, PA, 19141, USA
| | - Blake Turvey
- Department of Orthopedic Surgery, Einstein Healthcare Network, 5501 Old York Road, WCB4, Philadelphia, PA, 19141, USA
| | - Emmanuel M Illical
- Department of Orthopedic Surgery, Einstein Healthcare Network, 5501 Old York Road, WCB4, Philadelphia, PA, 19141, USA.
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28
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Abstract
RATIONALE Talus fracture is relatively rare in adults. Furthermore, talus fracture in pediatric population is rarer than in adult population. Although undisplaced talus fractures can be treated conservatively, most of talus fractures with displacement require surgical treatment in both pediatric and adult patients. In addition, avascular necrosis and arthrosis are the main complications of displaced talus fracture. PATIENT CONCERNS A 14-year-old boy was referred to our hospital owing to foot injury sustained on jumping off about 10 stairs. DIAGNOSIS Highly displaced talus body fracture of the dome and the posterior process. INTERVENTIONS Because the Linhart classification of this case was III-C and instability at the fracture site persisted even after closed reduction, we performed arthroscopic-assisted reduction and internal fixation (ARIF) using headless screws and an external fixator under general anesthesia. OUTCOMES We removed the external fixator at 3 months after the surgery. At the 1-year follow-up, the patient was able to walk with full weight bearing and his Japanese Orthopaedic Association score recovered from 9 points before the surgery to 95 points. The range of motion of dorsiflexion and plantarflexion was 10° and 60°, respectively, which were similar to that on the left side. No signs of bone necrosis or arthrosis were observed on imaging. LESSONS ARIF with external fixation might be the treatment of choice for such a case.
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29
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Buza JA, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg 2018; 24:282-290. [PMID: 29409210 DOI: 10.1016/j.fas.2017.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/09/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
Fractures of the talus are challenging to manage, with historically poor outcomes and a high rate of complications. The rare nature of this injury limits the number of studies available to guide treatment. Fortunately, a number of advancements have been made in the last decade. There is increased recognition regarding the importance of anatomic reconstruction of the osseous injury. Advanced imaging is used to assess the subtalar joint, where even slight displacement may predispose to arthritis. Increasing use of dual anteromedial and anterolateral approaches, along with plate fixation, has improved our ability to accurately restore the anatomy of the talus. Modification of the original Hawkins classification can both guide treatment and allow us to better predict which patients will develop avascular necrosis. Lastly, improved reconstructive techniques help address the most common complications after talus fracture, including arthritis, avascular necrosis, and malunion.
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Affiliation(s)
- John A Buza
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States
| | - Philipp Leucht
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States.
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30
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Abstract
Avascular necrosis (AVN) of the talus can be a cause of significant disability and is a difficult problem to treat. The most common cause is a fracture of the talus. We have done a systematic review of the literature with the following aims: (1) identify and summarize the available evidence in literature for the treatment of talar AVN, (2) define the usefulness of radiological Hawkins sign and magnetic resonance imaging in early diagnosis, and (3) provide patient management guidelines. We searched MEDLINE and PUBMED using keywords and MESH terminology. The articles' abstracts were read by two of the authors. Forty-one studies met the inclusion criteria of the 335 abstracts screened. The interventions of interest included hindfoot fusion, conservative measures, bone grafting, vascularized bone graft, core decompression, and talar replacement. All studies were of Level IV evidence. We looked to identify the study quality, imprecise and sparse data, reporting bias, and the quality of evidence. Based on the analysis of available literature, we make certain recommendations for managing patients of AVN talus depending on identified disease factors such as early or late presentation, extent of bone involvement, bone collapse, and presence or absence of arthritis. Early talar AVN seems best treated with protected weight bearing and possibly in combination with extracorporeal shock wave therapy. If that fails, core decompression can be considered. Arthrodesis should be saved as a salvage procedure in late cases with arthritis and collapse, and a tibiotalocalcaneal fusion with bone grafting may be needed in cases of significant bone loss. Role of vascularized bone grafting is still not defined clearly and needs further investigation. Future prospective, randomized studies are necessary to guide the conservative and surgical management of talar AVN.
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Affiliation(s)
- Mandeep S Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Balvinder Rana
- Department of Orthopaedics, Fortis Bone and Joint Institute, Fortis Hospitals, New Delhi, India
| | - Inayat Panda
- Department of Orthopaedics, Fortis Bone and Joint Institute, Fortis Hospitals, New Delhi, India
| | - Sandeep Patel
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prasoon Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Wagener J, Schweizer C, Zwicky L, Horn Lang T, Hintermann B. Arthroscopically assisted fixation of Hawkins type II talar neck fractures: a case series. Bone Joint J 2018; 100-B:461-467. [PMID: 29629582 DOI: 10.1302/0301-620x.100b4.bjj-2017-0772.r3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims 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. Patients and Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- J Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4101 Bruderholz, Switzerland
| | - C Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - L Zwicky
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - B Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
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Kwak JM, Heo SK, Jung GH. Six-year survival of reimplanted talus after isolated total talar extrusion: a case report. J Med Case Rep 2017; 11:348. [PMID: 29241447 PMCID: PMC5731080 DOI: 10.1186/s13256-017-1517-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022] Open
Abstract
Background Open total extrusion of the talus without concomitant fracture is an extremely rare injury. We present 6-year follow-up data of a patient treated using a temporary spanning external fixator and less invasive single K-wire fixation. Case presentation A 55-year-old Asian man who had a totally extruded talus without fracture underwent immediate reimplantation surgery. A spanning external fixator with single antegrade K-wire fixation was applied to maintain the reimplanted talus. During 6 years of follow-up, he could walk without aids and could squat, corresponding to an American Orthopaedic Foot and Ankle Society score of 85. We found that the suspect lesion that was evident at 6 months after surgery had disappeared at 12 months postoperatively on the basis of sequential follow-up magnetic resonance imaging. There was no evidence of osteonecrosis of the dislocated talus at the final follow-up. Conclusions In patients with a totally extruded talus, a surgical strategy including immediate reimplantation of the talus and a temporary spanning fixator with single K-wire fixation might be useful to allow early mobilization around the ankle joint and to prevent additional damage of the foot without significant complications.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Keun Heo
- Department of orthopaedic surgery, Gi-Jang Hospital, Busan, Republic of Korea
| | - Gu-Hee Jung
- Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, and Gyeongsang National University Changwon Hospital, 555 Samjungja-Dong, Changwon-si, 642-160, Republic of Korea.
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J R B, Ma A, W K, A OG. The Diagnosis, Management and Complications Associated with Fractures of the Talus. Open Orthop J 2017; 11:460-466. [PMID: 28694883 PMCID: PMC5481613 DOI: 10.2174/1874325001711010460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/24/2017] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
Fractures of the talus are uncommon injuries that can have devastating consequences. The blood supply to the talus is tenuous and injuries are associated with a higher incidence of avascular necrosis and malunion. Talar neck fractures are the most common fractures. This review looks at the different types of fractures of the talus, particularly focusing on talar neck fractures. The diagnosis and management are discussed as well as the complications.
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Affiliation(s)
- Barnett J R
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Ahmad Ma
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Khan W
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - O' Gorman A
- Department of Trauma and Orthopaedics, The Whittington Hospital, Magdala Ave, London, N19 5NF, UK
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Maher MH, Chauhan A, Altman GT, Westrick ER. The Acute Management and Associated Complications of Major Injuries of the Talus. JBJS Rev 2017; 5:e2. [DOI: 10.2106/jbjs.rvw.16.00075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Zermatten P, Steinmetz S, Rotigliano N. Isolated open total talar dislocation: A case report and literature review. ARCHIVES OF TRAUMA RESEARCH 2017. [DOI: 10.4103/atr.atr_18_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES To assess the healing and radiographic outcomes of displaced and comminuted talar neck fractures treated with medial position screws augmented with lateral minifragment plate fixation. DESIGN Retrospective case series. SETTING Two level I trauma centers. PATIENTS The records of 26 patients with displaced and comminuted talar neck fractures who underwent open reduction and internal fixation with medial-sided position screws augmented with lateral minifragment plates. INTERVENTION Surgery consisted of medial and lateral approaches to the talus, fixation with a laterally placed minifragment plate, and screw construct augmenting sagittal-plane-oriented, medial-sided position screws. MAIN OUTCOME MEASUREMENTS The incidences of nonunion, malunion, avascular necrosis, post-traumatic arthritis, and symptomatic implants. RESULTS Nonunion occurred in 3/26 (11.5%) displaced and comminuted talar neck fractures. There were no instances of malunion. Avascular necrosis developed in 7/26 (27%) cases. Post-traumatic arthritis was the most common complication affecting 10/26 (38%) tali. The subtalar joint was most commonly affected. There were no instances of hardware removal due to symptomatic medial impingement. CONCLUSIONS Lateral minifragment plate fixation augmenting medially placed sagittal plane position screws provides a length stable construct that prevents talar neck shortening and malunion. Medial position screws can help avoid secondary surgeries for removal of symptomatic implants due to medial impingement as is common with medially based minifragment plates. This fixation strategy should be considered in the setting of displaced and comminuted talar neck fractures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
OBJECTIVES Avascular necrosis (AVN) of the femoral head is a devastating complication following fixation of femoral neck fractures in younger adults. In this study, we investigate the prognostic utility of disuse osteopenia. DESIGN Retrospective study. SETTING Three academic Level 1 trauma centers. PATIENTS One hundred twenty patients younger than 60 years treated for a femoral neck fracture. INTERVENTION N/A. MAIN OUTCOME MEASURES The presence of sclerosis or osteopenia, compared to the contralateral femoral head, was measured 6 weeks from injury both subjectively and using a novel radiographic measure, the relative density ratio (RDR). The outcome measure was radiographic development of AVN. RESULTS The presence of relative sclerosis was associated with AVN and overall treatment failure. Patients with subjective relative sclerosis had a 12.6 (95% confidence interval, 2.9-61.3; P < 0.001) times higher odds of developing AVN. Multiple logistic regression showed that for every 0.10 increase in the RDR, there was a 5.2 increase in the odds (95% confidence interval, 2.1-26.9; P = 0.009) of developing AVN. Patients with an RDR of ≥1.2 have an 80% probability of AVN, whereas those with an RDR ≤0.8 have a <1% probability of developing AVN. CONCLUSIONS Disuse osteopenia detected on 6-week radiographs is a favorable prognostic sign following fixation of femoral neck fractures. Patients who have relative sclerosis of the femoral head at 6-week follow-up are at a higher risk of developing AVN. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Barg A, Suter T, Nickisch F, Wegner NJ, Hintermann B. Osteotomies of the Talar Neck for Posttraumatic Malalignment. Foot Ankle Clin 2016; 21:77-93. [PMID: 26915780 DOI: 10.1016/j.fcl.2015.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A talar neck malunion is one of the major complications following operative or nonoperative treatment of talar neck fractures. The most common posttraumatic talar malunion results in varus malalignment of the talar neck and can lead to painful overload of the lateral foot and substantial impairment of hindfoot function. Secondary procedures in patients with painful malunited talar neck fracture include salvage procedures and anatomic reconstruction procedures. Anatomic reconstruction of the talar neck is a reliable surgical treatment to regain function, decrease pain, and restore hindfoot alignment and range of motion.
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Affiliation(s)
- Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Thomas Suter
- Department of Orthopaedics and Trauma, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
| | - Florian Nickisch
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicholas J Wegner
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Beat Hintermann
- Department of Orthopaedics and Trauma, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
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Annappa R, Jhamaria NL, Dinesh KVN, Devkant, Ramesh RH, Suresh PK. Functional and radiological outcomes of operative management of displaced talar neck fractures. Foot (Edinb) 2015; 25:127-30. [PMID: 26025646 DOI: 10.1016/j.foot.2015.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/06/2015] [Accepted: 03/10/2015] [Indexed: 02/04/2023]
Abstract
AIM 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 Orthopedic 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. RESULTS 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 Orthopedic Foot and Ankle Society scores, excellent result was obtained in 4 cases, good 7 cases, fair 5 cases and poor 4 cases. CONCLUSION Talar neck fractures are associated with high rates of morbidity and complications. Post traumatic arthritis is more common complication than osteonecrosis following surgery.
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Affiliation(s)
- Rajendra Annappa
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore 575001, India.
| | | | - K V N Dinesh
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Mangalore 575001, India.
| | - Devkant
- Department of Orthopaedics, JLN Medical College, Ajmer, India.
| | - Raghu H Ramesh
- Department of Orthopaedics, BGS Medical College, Bangalore, India.
| | - Pooja K Suresh
- Department of Pathology, Kasturba Medical College, Manipal University, Mangalore 575001, India.
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Alton T, Patton DJ, Gee AO. Classifications in Brief: The Hawkins Classification for Talus Fractures. Clin Orthop Relat Res 2015; 473:3046-9. [PMID: 25586336 PMCID: PMC4523513 DOI: 10.1007/s11999-015-4136-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/05/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Timothy Alton
- Department of Orthopaedics and Sports Medicine, University of Washington, 325 9th Ave, Seattle, WA, 98104, USA,
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Abstract
OBJECTIVES To report the rates of osteonecrosis and subtalar arthritis after talar neck fractures and to examine if rates have changed over time. DATA SOURCES A systematic review and meta-analysis of the English literature was performed using EMBASE, MEDLINE, CENTRAL, and Cochrane in November 2011 and updated in November 2014. STUDY SELECTION Inclusion criteria were studies examining talar neck fractures that reported talar body osteonecrosis rates as a primary or secondary outcome. Exclusion criteria included case series with <10 patients or >50% pediatric patients, inability to isolate results of talar neck fractures, primary treatment of talar excision or arthrodesis, mean follow-up of <3 months, and non-English literature. DATA EXTRACTION Basic information was collected including journal, author, year published, level of evidence, number of fractures, and follow-up length. Specific information collected included fracture classifications, timing of interventions, method of treatment, osteonecrosis rates, subtalar arthrosis rates, and method of diagnosis of osteonecrosis. DATA SYNTHESIS Fixed-effects models were used for meta-analysis. The overall event rate of osteonecrosis was calculated and stratified based on Hawkins classification of the talar neck fractures. Mean rates of subtalar arthritis were calculated for all studies and for studies including >2 years of follow-up. CONCLUSIONS The overall rate of osteonecrosis was 0.312. Rates for Hawkins' types I-IV were 0.098, 0.274, 0.534, and 0.480, respectively. The mean rate of subtalar arthritis was 0.49 but increased to 0.81 in studies with >2 years of follow-up. Complication rates are high in talar neck fractures, and patients should be counseled accordingly.
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Chen H, Liu W, Deng L, Song W. The prognostic value of the hawkins sign and diagnostic value of MRI after talar neck fractures. Foot Ankle Int 2014; 35:1255-61. [PMID: 25116131 DOI: 10.1177/1071100714547219] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures. METHODS Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated. RESULTS The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures. CONCLUSION The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases. LEVEL OF EVIDENCE Level III, comparative case series.
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Affiliation(s)
- Hao Chen
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China Department of Orthopaedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Wenzhou Liu
- Department of Orthopaedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
| | - Lianfu Deng
- Shanghai Institute of Traumatology and Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Ruijin Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Weidong Song
- Department of Orthopaedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong, China
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Rammelt S, Winkler J, Zwipp H. Osteosynthese zentraler Talusfrakturen. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2013; 25:525-41. [DOI: 10.1007/s00064-013-0245-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 11/27/2022]
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Rodríguez-Paz S, Muñoz-Vives J, Froufe-Siota M. Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus? Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Rodríguez-Paz S, Muñoz-Vives JM, Froufe-Siota MÁ. [Is the Hawkins sign able to predict necrosis in fractures of the neck of the astragalus?]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:403-8. [PMID: 24183388 DOI: 10.1016/j.recot.2013.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/05/2013] [Accepted: 09/07/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess if the Hawkins sign can predict whether or not astragalus fractures of the neck will develop avascular necrosis. It is also assessed whether the occurrence of this complication is related to the displacement of the fracture, soft tissue injury, or delay in the reduction or surgery. The results were compared with those found in the literature. MATERIAL AND METHODS A retrospective study was conducted on 23 talar neck fractures recorded over a a period of thirteen years. The following variables were analysed: displacement of the fracture, soft tissue injury, delay and type of treatment, complications, observation of the Hawkins sign, and functional outcome. RESULTS There were 7 type I Hawkins fractures, 11 type II, and 4 type III and 1 type IV. Four cases developed avascular necrosis (2 Hawkins type II and 2 type III). Hawkins sign was observed in 12 cases, of which none developed necrosis. Four cases with negative Hawkins sign developed necrosis. No statistically significant differences were found when comparing the development of avascular necrosis with the displacement of the fracture, soft tissue injury, or delay in treatment. Differences were found when comparing the development of avascular necrosis with the Hawkins sign (P=.03). CONCLUSION A positive Hawkins sign rules out that the fractured talus has developed avascular necrosis, but its absence does not confirm it.
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Affiliation(s)
- S Rodríguez-Paz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Girona Josep Trueta, Girona, España.
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Abstract
Talus fractures result from high-energy mechanisms and usually occur at the neck. Functional outcome after talar neck fracture worsens with increasing Hawkins grade. The mainstay of treatment for talar neck fractures is anatomic reduction and internal fixation. Prompt reduction of dislocations should be performed. Patients should be taken to the operating room as soon as stabilized. Dual incisions and a combination of minifragment plates and screws should be used. Talar body fractures have a high rate of ankle and subtalar arthritis. Lateral process fractures are frequently missed on radiographs. Complications after talus fractures include osteonecrosis, malunion, post-traumatic arthritis, and infection.
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Affiliation(s)
- Rachel J Shakked
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA
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47
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48
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Sofka CM. Postoperative magnetic resonance imaging of the foot and ankle. J Magn Reson Imaging 2013; 37:556-65. [DOI: 10.1002/jmri.23792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/27/2012] [Indexed: 11/06/2022] Open
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Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, Falaise V, Pineau V, Salle de Chou E, Noailles T, Carvalhana G, Ruhlmann F, Huten D. Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res 2012; 98:S48-55. [PMID: 22621831 DOI: 10.1016/j.otsr.2012.04.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/13/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Displaced talar neck and body fractures are rare and challenging for the surgeon. Results are often disappointing due to inadequate reduction or internal fixation and high rates of osteoarthritis and osteonecrosis. Very few published series describe the long-term results after internal fixation of talar factures. One of the goals of the 2011 SOO meeting symposium was to specifically evaluate the long-term results after internal fixation of talar fractures. This study included only central fractures. MATERIAL AND METHODS We reviewed the results of 114 central talar fractures that had been treated by internal fixation between 1982 and 2006 in nine hospitals in the Western part of France. The clinical and radiological follow-up was 111 months on average. All the patients with a radiological assessment had at least 5 years of follow-up. RESULTS Poor reduction was apparent in 33% of cases. The average Kitaoka score was 70/100, which corresponds to an average functional level. At the last follow-up evaluation, 34% of cases had osteonecrosis and 74% had peritalar osteoarthritis. Secondary fusion was required in 25% of cases with an average follow-up of 24 months. DISCUSSION The complication rate for talar fractures was high, mostly due to osteonecrosis and osteoarthritis; these conditions had an impact on the final outcome. The outcome could be improved by better evaluating these fractures with a CT scan, developing dual surgical approaches to best preserve the bone vascular supply and achieve better reduction, and improving the internal fixation hardware, especially the use of plates for comminuted fractures.
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Affiliation(s)
- A Fournier
- Service de chirurgie orthopédique, CHU Hôpital Sud, 16, boulevard de Bulgarie, 35200 Rennes cedex 2, France
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Abstract
We present a rare case of complete talar extrusion after trauma. Treatment of this severe injury remains controversial as a result of the lack of congruent evidence-based literature, associated high complication rate with primary repair, and difficulty in objectively assessing long-term outcomes. Recent small sampled retrospective studies and isolated case reports have documented success with immediate reimplantation of the talus through using various health status questionnaires and serial radiographs. This case illustrates complete revascularization on 1-year follow-up magnetic resonance imaging of a completely extruded and fractured talus that underwent immediate reimplantation.
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