Partial Avascular Necrosis After Talar Neck Fracture

Babu, Nina; Schuberth, John M.

doi:10.3113/fai.2010.0777

Cited by 28 publications

(10 citation statements)

References 19 publications

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“…The medial malleolar osteotomy approach not only fully exposes the head, neck, and body of talus but also allows for direct observation of any injuries to the subtalar and tibiotalar joints. Additionally, this approach that cuts midway between the anterior tibial and deltoid artery may better preserve the vascularity of talus [11, 17]. Ziran et al [18].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation

Liu¹,

Zeng²,

Xiong³

et al. 2017

J Orthop Surg Res

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BackgroundFractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. In the present study, we report a surgical treatment of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation and discuss the therapeutic effects after long-term follow-up.MethodsFrom January 2010 to January 2015, 21 patients with 22 fractures were treated using this approach within days of sustaining the injury. Clinical and radiographic data were collected during regular post-operative follow-ups. Health-related quality of life factors were evaluated using visual analogue scale (VAS). Functional outcomes were determined according the Hawkins score and the Ankle-Hind foot Scale of the American Orthopedic Foot and Ankle Society (AOFAS). Present of complications such as arthritis, avascular necrosis (AVN), and malunion were evaluated using radiographs and magnetic resonance imaging (MRI). Anatomical parameters of injured and corresponding uninjured talus were measured and compared using digital three-dimensional (3D) computer model.ResultsThe mean duration of surgery was 65.6 ± 9.7 min. The average blood loss volume of the patients was 29.1 ± 5.7 ml. All the patients except 1 were followed up 18 to 41 months (average 29.6 months). The average VAS score for these patients was 3.2 ± 1.1, and the mean Hawkins score was 11.4 ± 3.4 at the final follow-up visit. The average AOFAS score was 72.8 ± 17.3. Nine patients outcomes were rated as “excellent”, 4 as “good”, 4 as “fair,” and 4 as “poor”. No malunion, screw loosening, plate breakage, or other internal fixation failures were found at final follow-up. Long-term complications included: 1 case of malunion, 5 cases of complete AVN, 8 cases of partial AVN, 13 cases of talocrural arthritis, 14 cases of subtalar arthritis, and 3 cases of talonavicular arthritis. Secondary surgery was performed in 4 cases. The relevant average anatomical data of injured and uninjured talus show no significant difference.ConclusionsThis surgical treatment we used here resulted in decreased soft tissue trauma, adequate exposure of talar neck, satisfactory performance of daily life activities, and quality of life following surgery and restoration of anatomy of injured talus. However, long-term complications such as arthritis and AVN are still commonly seen.

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Section: Discussionmentioning

confidence: 99%

Surgical management of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation

Liu¹,

Zeng²,

Xiong³

et al. 2017

J Orthop Surg Res

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“…Примерно в половине случаев этот ранний признак исчезает за счет реваскуляризации кости без коллапса, что, однако, может требовать до 2 лет после травмы. Частота развития данного осложения достигает 41% [11,17,19,20,21] [17].…”

Section: осложненияunclassified

Treatment of the Fractures of the Neck of the Talus

Sitnik¹,

Scientific²

2019

Novosti Khirurgii

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Переломы таранной кости являются редкими повреждениями (до 2,5% от переломов костей стопы), однако при неправильном лечении характеризуются стойкими последствиями в виде посттравматического артрита. Пугающим осложнением при переломах таранной кости остается аваскулярный некроз тела, частота которого, по данным ранних сообщений, составляла до 50-75%. Изменения хирургической стратегии, произошедшие за последние десятилетия, привели к снижению частоты осложнений и улучшению результатов лечения. Показаниями к неотложному хирургическому лечению в настоящее время считаются открытые повреждения, а также переломо-вывихи таранной кости, при которых смещенный костный фрагмент вызывает угрозу жизнеспособности кожных покровов. При удачном закрытом устранении вывиха выполнение открытой репозиции и внутренней фиксации рекомендуется производить в отсроченном порядке, после нормализации состояния мягких тканей. По современным данным литературы, такой этапный подход не приводит к увеличению частоты аваскулярного некроза, но достоверно снижает частоту раневых осложнений и улучшает долгосрочные результаты за счет более тщательного планирования и выполнения окончательного остеосинтеза. Применение двух хирургических доступов (передне-медиального и передне-латерального) обеспечивает более точную репозицию перелома с сохранением кровоснабжения таранной кости. Ключевые слова: таранная кость, перелом, сроки лечения, остеосинтез, осложнения Fractures of the talus are rare injuries (up to 2.5% from the foot fractures), but the consequences of incorrect treatment are catastrophic, leading to osteoarthritis and long-lasting function impairment. Fearing complication is avascular necrosis of the body of the talus with previously reported incidence up to 50-75%. The changes of surgical strategy during the last decades have led to significant improvement of results and decrease of complications. Urgent treatment is only indicated in open injuries, as well in cases of fracture-dislocations where the displaced bone fragment threatens with skin necrosis. If closed reduction is successful, internal fixation is better to perform in delayed manner after the resolution of soft-tissue swelling. According to the present-day literature data, such an approach does not lead to the increase of the rate of avascular necrosis, but reduces the rate of wound complications and improves long-term results by thorough pre-operative planning and execution of surgery. The use of double surgical approaches (antero-medial and antero-lateral) provides anatomic fracture reduction with maintenance of the tiny blood supply of talus bone.

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“…ON of the foot most commonly occurs in either the talus or the navicular and is often cited as occurring as a result of their blood supply being very intricate and vulnerable to injury owing their relatively large articular surface area (18). In that regard, they are similar to the femoral head in that its blood supply is tenuous and can be easily compromised.…”

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confidence: 99%

Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature

McLeod¹,

Kruse

et al. 2017

The Journal of Foot and Ankle Surgery

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Osteonecrosis, although commonly occurring in the hip, can also affect the leg and foot. In the foot, it most commonly occurs in the talus. The incidence of osteonecrosis occurring in the tibia is relatively rare. We report a case of a woman who presented to our clinic with ankle pain that was idiopathic in nature. Subsequent magnetic resonance imaging showed findings consistent with osteonecrosis of the bilateral distal tibias and several other lesions located in the shoulder, hip, and calcaneus. The present report also serves as a review of both etiology and treatment of osteonecrosis as it relates to the lower extremity.

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Partial Avascular Necrosis After Talar Neck Fracture

Cited by 28 publications

References 19 publications

Surgical management of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation

Surgical management of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation

Treatment of the Fractures of the Neck of the Talus

Nontraumatic Osteonecrosis of the Distal Tibia: A Case Presentation and Review of the Literature

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