Long-term follow-up after surgical treatment of talar fractures

Abstract

Displaced talus fractures are rare and serious injuries with important outcomes. These fractures compromise motion of the foot and ankle and result in severe disability. Therefore, a satisfactory clinical outcome remains a challenge in the treatment of talus fractures. Displaced talar fractures have a high rate of long-term complications. The aim of our study was to evaluate the long-term outcomes of these fractures after operative treatment. This prospective study was conducted to assess the long-term outcome of all operated talus fractures who presented to emergency department of orthopedics, Govt. Bone and Joints Hospital, Barzillai an associated Hospital of Govt. Medical College, Srinagar from June 2019 to January 2022. Reduction was anatomical in 5 (25%) cases, nearly anatomical reduction in 10 (50%) and poor in 5 (25%). Early complications included 2 (10 %) superficial wound infections, 1 (5 %) deep infection and delayed union in 3 (15 %) patients. 4 (20%) patients presented an osteonecrosis of the talus. 5 (25 %) had undergone secondary surgery. 12 (60%) patients presented post-traumatic osteoarthritis in at least one ankle joint. 8 (47.05 %) patients had a normal hindfoot alignment, in 6 (35.29%) patients there was a varus malunion (from 8° of varus to 3° of valgus) and in 3 (17.65 %) cases there was a valgus malunion (10° and 12° of valgus). The average functional score was 69 points (range 43-92 points). Clinical outcome based on ankle-hind foot scoring was rated as excellent in 1 (5 %), good in 10 (50 %), fair in 5 (25 %), and poor in 4 (20 %). The complication rate for talar fractures was high, mostly osteonecrosis and osteoarthritis. 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.