Paediatric talus fractures: A guide to management based on a review of the literature

Waseem, S; Nayar, Sandeep Krishan; Vemulapalli, Krishna C.

doi:10.1016/j.injury.2021.12.024

Cited by 3 publications

(1 citation statement)

References 30 publications

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“…Talus fractures are rare in children, with a reported incidence of 0.01% to 0.08% [ 1 , 2 ]. The main clinical manifestations are obvious swelling and pain in the ankle after fracture, which seriously affect the functional activities of the ankle joint.…”

Section: Introductionmentioning

confidence: 99%

Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study

Huang,

Ruan,

Lei

et al. 2023

J Orthop Surg Res

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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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Section: Introductionmentioning

confidence: 99%

Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study

Huang,

Ruan,

Lei

et al. 2023

J Orthop Surg Res

View full text Add to dashboard Cite

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Anteromedial cannulated screw fixation for Hawkins Ⅱ/Ⅲ talus fractures in children: a retrospective study

Huang¹,

Ruan²,

Lei³

et al. 2023

Preprint

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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 (AOFAS) ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale (VAS) 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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Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Kubisa,

Pałka

et al. 2024

Medicina

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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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Paediatric talus fractures: A guide to management based on a review of the literature

Cited by 3 publications

References 30 publications

Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study

Anteromedial cannulated screw fixation for Hawkins II/III talus fractures in children: a retrospective study

Anteromedial cannulated screw fixation for Hawkins Ⅱ/Ⅲ talus fractures in children: a retrospective study

Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

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