Talar Neck Fractures

Berlet, Gregory C.; Lee, Thomas H.; Massa, Eric G.

doi:10.1016/s0030-5898(05)70193-0

Cited by 50 publications

(27 citation statements)

References 38 publications

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“…The blood supply to the talus is rich; however, most of the vessels enter the head of the talus and supply the body in a retrograde manner, so the blood supply to the talar body is vulnerable and carries a very high risk of avascular necrosis with displaced fractures. The incidence frequently coincides with the severity of the injuries and ranges from 0-15 % in Hawkins type I fractures to 69-100 % in type III and IV fractures [13,14]. Many studies regard fracture displacement and delayed surgery as the key risk factors and recommend immediate ORIF to decrease the incidence of this dreaded complication.…”

Section: Discussionmentioning

confidence: 99%

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Xue

Zhang

Pei

et al. 2013

International Orthopaedics (SICOT)

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Purpose Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. Methods In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36. Results Twenty-eight patients were followed up for an average of 25 months (range 18-50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12-24 weeks). Posttraumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65-91). According to the SF-36, the average score of the physical component summary was 68 (range 59-81), and the average score of the mental component summary was 74 (range 63-85). Conclusions Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Xue

Zhang

Pei

et al. 2013

International Orthopaedics (SICOT)

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“…In fracture-dislocation of the talus, immediate reduction is recommended to prevent severe soft tissue injury and to protect blood supply to the posterior portion of the talar body [13][14][15][16]. Closed reduction may be attempted under adequate analgesia.…”

Section: Treatmentmentioning

confidence: 99%

Talar Neck Fractures: An Overview

Rao¹,

Ibrahim²,

Chahal³

et al. 2014

J Nov Physiother Phys Rehabil

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Talar injuries are infrequently encountered in practice as the majority require a high energy force such as road traffic accident or fall from height and they are often presented as complex injuries. Talar neck fracture accounts for half of these injuries. Because of the high rate of avascular necrosis (AVN) and posttraumatic arthritis associated with these injuries, it is difficult to predict the prognosis of AVN with the current classification systems. The anatomical position, difficulty of surgical approaches and its complex blood supply add to the challenges. Early recognition and a robust management plan are essential in treating such injuries. Failure to recognize a displaced talus fracture can result in Osteonecrosis, osteoarthritis, malunion or non-union which affects the hind foot function and results in pain, loss of motion and deformity. The integrity of this bone is vital for the function of the ankle, subtalar and mid tarsal joints. This article is an overview of this challenging injury including the mechanism of injury, classification, management and rehabilitation.Medial malleolus fracture is associated with talar neck fracture in 19-28% of cases [2]. In Hawkins study in 1970; found that 26% of talar neck fractures are associated with medial malleolus fracture, and Canale and Kelly found the incidence to be of 15% of talar neck fractures. This highlights the presence of rotational forces associated with these injuries [2,3,[5][6][7].Lumbar spines fractures are less commonly encountered with this injury but have been found to be associated [2,3,5]. Blood supply of the talus comes from three arteriesThese form extra osseous circulation as described by Wildenaur around the talar neck and sinus tarsi 1 .Anterior tibial artery gives off the medial tarsal artery branches and anterior medial malleolar branches to supply the superior aspect of the talar neck at the level of ankle joint. The dorsalis pedis artery which is the continuation of anterior tibial artery, gives off the tarsal sinus artery, together with the lateral malleolar branch of the peroneal artery [2], they supply the talar head and distal talar body before anastomosing with tarsal canal artery [5].Posterior tibial artery branches are divided into calcaneal branches which supply the periosteum and most of the posterior aspect of the talus. It also divides to form artery of tarsal canal, 2 cm below the ankle and passes through the deltoid ligament to give off the deltoid branch to supply the medial talar body and then anastomose with dorsalis pedis over the neck of the talus and also it supplies the middle of talar body as it passes through thesuperior part of the tarsal canal [2,5].Perforating branch of peroneal artery gives small branches to anastomose with both calcaneal branches of posterior tibial artery and to dorsalis pedis to form the artery of tarsal sinus [5]. Fortin et al. described the arteries of tarsal canal and tarsal sinus as discrete blood vessels that form anastomotic sling inferior to the talus; these give branche...

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“…3), the screw was inserted from posterolateral to anteromedial through a small incision. In two of the aforementioned cases with type B fractures, autologous bone grafting was used [11].…”

Section: Operative Techniquementioning

confidence: 99%

Surgical Treatment of Talar Neck Fractures

Tyllianakis

Karageorgos

Papadopoulos

et al. 2004

European Journal of Trauma

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Background: Consideration of gravity of talar neck fractures and evaluation of the treatment results. Patients and Methods: 22 patients suffering from talar neck fractures were retrospectively reviewed. There were ten type A, six type B, three type C, and three type D fractures according to the Hawkins classification modified by Canale & Kelly. All patients underwent open reduction and internal fixation. Results: Excellent clinical results were observed in 45.4%, good in 27.2%, fair in 18.1%, and poor in 9.1% of the patients according to the Iowa Ankle Evaluation score. Two patients developed avascular necrosis (AVN) with body collapse, and tibiotalar fusion was required. Furthermore, five patients developed symptomatic subtalar arthritis but did not require subtalar fusion. Conclusion: Accurate early open reduction is considered the treatment of choice for such types of fractures. AVN is associated with late management, while subtalar arthritis does not necessarily lead to subtalar fusion.

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Talar Neck Fractures

Cited by 50 publications

References 38 publications

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Talar Neck Fractures: An Overview

Surgical Treatment of Talar Neck Fractures

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