Funktionsergebnisse nach operativer Therapie von Talusfrakturen

Abstract

Forty-five patients with fractures of the talus were treated operatively at the Department of Surgery in Bergmannsheil Hospital between 1989 and 1995. Of these, 21 patients were operated on the day of the accident. The Marti/Weber classification system was used: 9 fractures were type I, 12 type II, 18 type III and 6 type IV. Twenty-five neck-fractures were classified according to Hawkins (type I-6, type II-10, type III-6, type IV-3). The mean time of follow-up was 37.3 months (minimum of 12 months). One patient needed a primary and 2 other patients a secondary arthrodesis of the ankle and subtalar joint; 2 others required arthrodesis of the talonavicular joint. Eleven patients showed no complaints at follow-up. Twenty-five reported complaints only during strenuous exercise, 5 others during walking and 3 patients reported initial pain when walking. The mean time of therapy was 22.5 weeks. As a consequence of trauma, 7 patients changed their jobs. The most important prerequisites for successful surgery are early reduction and stable osteosynthesis. Residual complaints are frequently seen. The rate of avascular necrosis (8% in fractures of the neck of the talus) and the necessity for arthrodesis was significantly diminished.

Surgical treatment of talus fractures

“…However, we and other authors do not agree with this approach (Beck 1991, Dávid et al 1996, Schulze et al 1998.…”

“…The indications for surgical treatment and duration of no weight bearing are still disputed (Baumhauer and Alvarez 1995). Undisplaced talar neck fractures can be treated without surgery (Beck 1991, Dávid et al 1996, but to shorten the duration of joint immobilization, some authors recommend internal xation of Hawkins type I fractures (Hausel 1980, Haase et al 1995, Kundel et al 1995, Schulze et al 1998). There is a consensus that dislocated talar fractures should be operated on (Kundel et al 1995, Schulze et al 1998.…”

Evaluation of talus fractures treated with fixation- correlation of functional outcome with the fracture type and wound condition

“…14 We and other authors (Beck, David et al, Schulze et al) do not agree this approach. [15][16][17] In our series we have 2 cases primarily treated with arthrodesis (1 case with type III comminuted, 1 case with type IV). Both have fair to good functional outcome during follow up study.…”

Verletzungen des Sprungbeins

“…Größere periphere Fragmente sollten mit Kleinfragmentschrauben oder resorbierbaren Stiften refixiert werden [9]. Die konservative Therapie kann bei allen nicht dislozierten Talus- …”