Severe Talar Neck Fractures. Analysis of Treatment in 20 Cases
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Published:
Feb 14, 2022
Keywords:
Talar neck fractures, treatment, outcomes
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Abstract
Introduction: Talar neck fractures are rare but present a high rate of complications and reoperations. The objective of this work was to analyze and describe the complications in the medium and long term in 20 patients with talar neck fracture. Our hypothesis was that, in severe injuries, ORIF presents a high rate of complications that will require new surgical interventions.
Materials and Methods: We evaluated 20 patients with talar neck fracture: 6 Hawkins II (29%), 11 Hawkins III (52%), and 3 Hawkins IV (19%). The mean follow-up was 11 years. We analyzed the fracture pattern (simple or comminuted), the presence of associated injuries, complications, and the need to perform a new surgical procedure.
Results: 11 (55%) had associated injuries and 14 (70%) had comminution in the fracture line. We presented complications in 15 patients (75%). 9 (45%) patients required a second intervention to treat the complication.
Discussion: The factors most related to the development of complications and the need for a new intervention are: comminution in the fracture line, associated injuries in the ipsilateral lower limb, Hawkins type III and IV fractures, and exposed fractures. We believe that in severe talar neck injuries (Hawkins type III and IV) with one or more of these factors, primary arthrodesis reduces the risk of complications and new surgeries and shortens recovery time.
Materials and Methods: We evaluated 20 patients with talar neck fracture: 6 Hawkins II (29%), 11 Hawkins III (52%), and 3 Hawkins IV (19%). The mean follow-up was 11 years. We analyzed the fracture pattern (simple or comminuted), the presence of associated injuries, complications, and the need to perform a new surgical procedure.
Results: 11 (55%) had associated injuries and 14 (70%) had comminution in the fracture line. We presented complications in 15 patients (75%). 9 (45%) patients required a second intervention to treat the complication.
Discussion: The factors most related to the development of complications and the need for a new intervention are: comminution in the fracture line, associated injuries in the ipsilateral lower limb, Hawkins type III and IV fractures, and exposed fractures. We believe that in severe talar neck injuries (Hawkins type III and IV) with one or more of these factors, primary arthrodesis reduces the risk of complications and new surgeries and shortens recovery time.
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How to Cite
Macklin Vadell , A., Sperone , E., Bigatti, A., Iglesias , M., Atilmis , Y., Rofrano , M., Torterola , I., & Ortega Galvis, J. (2022). Severe Talar Neck Fractures. Analysis of Treatment in 20 Cases. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(1), 15-22. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1357
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Clinical Research
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References
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https://doi.org/10.1177%2F107110070602700616
2. Zwipp H. Severe foot trauma in combination with talar injuries. En: Tscherne H, Schatzker J (eds). Major fractures of the pilon, the talus and the calcaneus. Berlin/Heidelberg/New York: Springer-Verlag; 1993:123-35.
3. Sarrafian SK. Anatomy of the foot and ankle. Philadelphia: Lippincott; 1983.
4. Schwarzenbach B, Dora C, Lang A, Kissling RO. Blood vessels of the sinus tarsi and the sinus tarsi syndrome. Clin Anat 1997;10:173-82. https://doi.org/10.1002/(SICI)1098-2353(1997)10:3<173::AID-CA3>3.0.CO;2-V
5. Rammelt S, Zwipp H. Talar neck and body fractures. Injury 2009;40:120-35. https://doi.org/10.1016/j.injury.2008.01.021
6. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am 1970;52:991-1002. PMID: 5479485
7. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 1978;60(2):143-56. PMID: 417084
8. Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD. Functional outcomes following
displaced talar neck fractures. J Orthop Trauma 2004;18:265-70. https://doi.org/10.1097/00005131-200405000-00001
9. Lorentzen JE, Christensen SB, Krogsoe O, Sneppen O. Fractures of the neck of the talus. Acta Orthop Scand
1977;48:115-20. https://doi.org/10.3109/17453677708985121
10. Adelaar RS. Complex fractures of the talus. Instr Course Lect 1997;46:323-38. PMID: 9143977
11. Baumhauer JF, Alvarez RG. Controversies in treating talus fractures. Orthop Clin North Am 1995;26(2):335-51.
PMID: 7724196
12. Inokuchi S, Ogawa K, Usami N. Classification of fractures of the talus: Clear differentiation between neck and body fractures. Foot Ankle Int 1996;17:748-50. https://doi.org/10.1177/107110079601701206
13. Penny JN, Davis LA. Fractures and fracture–dislocations of the neck of the talus. J Trauma 1980;20:1029-37.
https://doi.org/10.1097/00005373-198012000-00004
14. Meinberg E, Agel J, Roberts C, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium–2018. J Orthop Trauma 2018;32(Suppl 1):S1-S170. https://doi.org/10.1097/BOT.0000000000001063
15. Casola L, Arrondo G, Niño Gomez D. Fracturas del cuello del talo: clasificación con criterio terapéutico. Informe preliminar. Tobillo y Pie 2017;9(2):138-41. Disponible en: https://jfootankle.com/tobilloypie/issue/view/108
16. Adelaar RS, Madrian JR. Avascular necrosis of the talus. Orthop Clin North Am 2004;35:383-95.
https://doi.org/10.1016/j.ocl.2004.02.010
17. Sanders R, Lindvall E. Fractures and fracture-dislocations of the talus. En: Coughlin MJ, Mann RA, Saltzman CA
(eds). Surgery of the foot and ankle. 8th ed., Philadelphia: Mosby/Elsevier; 2007:2075-136.
18. Metzger MJ, Levin JS, Clancy JT. Talar neck fractures and rates of avascular necrosis. J Foot Ankle Surg
1999;38:154-62. https://doi.org/10.1016/s1067-2516(99)80030-1
19. Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am 2004;86(8):1616-24. PMID: 15292407
20. Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the Hawkins classification for talar neck fractures:
which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am 2014;96:192-7.
https://doi.org/10.2106/JBJS.L.01680
21. Lindvall E, Haidukewych G, Dispasquale T, Herscovici D, Sandres R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am 2004;86:2229-34.
https://doi.org/10.2106/00004623-200410000-00014
22. Pajenda G, Vecsei V, Reddy B, Heinz T. Treatment of talar neck fractures: clinical results of 50 patients. J Foot
Ankle Surg 2000;39:365-75. https://doi.org/10.1016/s1067-2516(00)80072-1
23. Blair HC. Comminuted fractures and fracture dislocations of the body of the astragalus. Operative treatment. Am J Surg 1943;59:37-43. https://doi.org/10.1016/S0002-9610(43)90501-X
24. Dennis DM, Tullos HS. Blair tibiotalar arthrodesis for injuries to the talus. J Bone Joint Surg Am 1980;62:103-7.
PMID: 7351400
25. Shrivastava MP, Shah RK, Singh RP. Treatment of fracture dislocation of talus by primary tibiotalar arthrodesis
(Blair fusion). Injury 2005;36:823-6. https://doi.org/10.1016/j.injury.2004.07.036
https://doi.org/10.1177%2F107110070602700616
2. Zwipp H. Severe foot trauma in combination with talar injuries. En: Tscherne H, Schatzker J (eds). Major fractures of the pilon, the talus and the calcaneus. Berlin/Heidelberg/New York: Springer-Verlag; 1993:123-35.
3. Sarrafian SK. Anatomy of the foot and ankle. Philadelphia: Lippincott; 1983.
4. Schwarzenbach B, Dora C, Lang A, Kissling RO. Blood vessels of the sinus tarsi and the sinus tarsi syndrome. Clin Anat 1997;10:173-82. https://doi.org/10.1002/(SICI)1098-2353(1997)10:3<173::AID-CA3>3.0.CO;2-V
5. Rammelt S, Zwipp H. Talar neck and body fractures. Injury 2009;40:120-35. https://doi.org/10.1016/j.injury.2008.01.021
6. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am 1970;52:991-1002. PMID: 5479485
7. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 1978;60(2):143-56. PMID: 417084
8. Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD. Functional outcomes following
displaced talar neck fractures. J Orthop Trauma 2004;18:265-70. https://doi.org/10.1097/00005131-200405000-00001
9. Lorentzen JE, Christensen SB, Krogsoe O, Sneppen O. Fractures of the neck of the talus. Acta Orthop Scand
1977;48:115-20. https://doi.org/10.3109/17453677708985121
10. Adelaar RS. Complex fractures of the talus. Instr Course Lect 1997;46:323-38. PMID: 9143977
11. Baumhauer JF, Alvarez RG. Controversies in treating talus fractures. Orthop Clin North Am 1995;26(2):335-51.
PMID: 7724196
12. Inokuchi S, Ogawa K, Usami N. Classification of fractures of the talus: Clear differentiation between neck and body fractures. Foot Ankle Int 1996;17:748-50. https://doi.org/10.1177/107110079601701206
13. Penny JN, Davis LA. Fractures and fracture–dislocations of the neck of the talus. J Trauma 1980;20:1029-37.
https://doi.org/10.1097/00005373-198012000-00004
14. Meinberg E, Agel J, Roberts C, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium–2018. J Orthop Trauma 2018;32(Suppl 1):S1-S170. https://doi.org/10.1097/BOT.0000000000001063
15. Casola L, Arrondo G, Niño Gomez D. Fracturas del cuello del talo: clasificación con criterio terapéutico. Informe preliminar. Tobillo y Pie 2017;9(2):138-41. Disponible en: https://jfootankle.com/tobilloypie/issue/view/108
16. Adelaar RS, Madrian JR. Avascular necrosis of the talus. Orthop Clin North Am 2004;35:383-95.
https://doi.org/10.1016/j.ocl.2004.02.010
17. Sanders R, Lindvall E. Fractures and fracture-dislocations of the talus. En: Coughlin MJ, Mann RA, Saltzman CA
(eds). Surgery of the foot and ankle. 8th ed., Philadelphia: Mosby/Elsevier; 2007:2075-136.
18. Metzger MJ, Levin JS, Clancy JT. Talar neck fractures and rates of avascular necrosis. J Foot Ankle Surg
1999;38:154-62. https://doi.org/10.1016/s1067-2516(99)80030-1
19. Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am 2004;86(8):1616-24. PMID: 15292407
20. Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the Hawkins classification for talar neck fractures:
which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am 2014;96:192-7.
https://doi.org/10.2106/JBJS.L.01680
21. Lindvall E, Haidukewych G, Dispasquale T, Herscovici D, Sandres R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am 2004;86:2229-34.
https://doi.org/10.2106/00004623-200410000-00014
22. Pajenda G, Vecsei V, Reddy B, Heinz T. Treatment of talar neck fractures: clinical results of 50 patients. J Foot
Ankle Surg 2000;39:365-75. https://doi.org/10.1016/s1067-2516(00)80072-1
23. Blair HC. Comminuted fractures and fracture dislocations of the body of the astragalus. Operative treatment. Am J Surg 1943;59:37-43. https://doi.org/10.1016/S0002-9610(43)90501-X
24. Dennis DM, Tullos HS. Blair tibiotalar arthrodesis for injuries to the talus. J Bone Joint Surg Am 1980;62:103-7.
PMID: 7351400
25. Shrivastava MP, Shah RK, Singh RP. Treatment of fracture dislocation of talus by primary tibiotalar arthrodesis
(Blair fusion). Injury 2005;36:823-6. https://doi.org/10.1016/j.injury.2004.07.036