FUNCTIONAL OUTCOMES OF OPERATIVE MANAGEMENT OF TALAR NECK FRACTURE

Main Article Content

Dr. Gouranga Prasad Nandi
Dr. Biswajit Sahu
Dr Sujit Kumar Lakra
Dr. Lorika Sahu

Keywords

AOFAS score, Complications, Hawkin’s classification, Talus fracture

Abstract

Background: Fractures of the talus neck necessitate surgery due to the possibility of serious long-term consequences if left untreated. However, given the peculiar anatomy and fragile blood supply, talus fractures can be challenging to fix. The current study was undertaken to analyze the functional outcomes of operative management of talus fractures.


 Material and Method: This was a prospective study conducted over a period of 2 years on 20 patients with talus neck fracture. All patients were subjected to open reduction and internal fixation of the fractures with cannulated cancellous screws and followed-up clinically and radiologically.


 Result: The average age of the study participants was 33.4±10.0 years. Hawkin's type III was the most frequently encountered talus fracture. The antero-lateral approach had significantly higher AOFAS scores (p=0.005), OM scores (p=0.003), and BJ scores (p=0.004) than the antero-medial and the dual approach. There was a significant co-relation between the Hawkin’s type and the AOFAS score (p=0.03), OM score (p=0.04), and BJ score (p=0.02). The incidence of avascular necrosis was significantly higher with type III talar neck fractures (p=0.04) among our study subjects.


 Conclusion: The quality of fracture reduction is the only modifiable parameter that can determine the success of the operative treatment in restoring the articular congruence. Although talus fractures should not be deemed as operative emergencies, efforts should be made to restore the articular alignment as soon as possible in order to improve the success rates of the reduction

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References

1. Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the Talus: Current Concepts. Foot Ankle Orthop. 2020;5(1):1–10.
2. Buza JA, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg. 2018;24(4):282–90.
3. Haverkort JJM, Leenen LPH, Wessem KJPV. Diagnosis and treatment of talar dislocation fractures illustrated by 3 case reports and review of literature. Int J Surg Case Rep. 2015;16:106–11.
4. Canale S, Kelly F. Fractures of the neck of the talus . Long-term evaluation of seventy-one cases. J Bone Jt Surg Am [Internet]. 1978;60(2):1978. Available from:
https://pubmed.ncbi.nlm.nih.gov/417084/
5. Williams L, Wilkins. American Orthopedic Foot and Ankle Society (AOFAS) score. In 2022. Available from: https://cdn-links.lww.com/permalink/poi/a/poi_46_0_2022_05_02_tokutake_ poi-d-21-00192r1_sdc1.pdf
6. Büker N, Şavkın R, Gökalp O, Ök N. Validity and Reliability of Turkish Version of Olerud-Molander Ankle Score in Patients With Malleolar Fracture. J Foot Ankle Surg. 2017;56(6):1209–12.
7. Mohapatra A, Raj K. Functional outcome after surgical treatment of ankle fracture using Baird Jackson score. Int J Res Orthop. 2018;4(4):638.
8. Russell TG, Byerly DW. Talus Fracture [Internet]. Russell TG, Byerly DW, editors. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK539687/
9. Vosoughi AR, Fereidooni R, Shirzadi S, Zomorodian SA. Different patterns and characteristics of Talar injuries at two main orthopedic trauma centers in Shiraz , south of Iran. BMC Musculoskelet Disord. 2021;22:1–13.
10. Dale JD, Ha AS, Chew FS. Update on talar fracture patterns: A large level I trauma center study. Am J Roentgenol. 2013;201(5):1087–92.
11. Pradhan A, Najefi A, Patel A, Vris A, Heidari N, Malagelada F, et al. Complications after talus fractures : A trauma centre experience. Injury [Internet]. 2023;54(2):772–7. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0020138322009172
12. Halim MAHBA, Alias A Bin, Ahmad ARBH. A displaced talus fracture in paediatrics. Foot Ankle Surg Tech Reports Cases. 2022;2(1):100142.
13. Sudharsan A, Siva E. Open reduction and internal fixation of talar fractures using various approaches and its outcome: A case series study. J Med Sci Clin Res. 2018;6(5):169–77.
14. Biz C, Golin N, De Cicco M, Maschio N, Fantoni I, Frizziero A, et al. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: The timing of surgical management. BMC Musculoskelet Disord. 2019;20(1):1–11.
15. Sundararajan SR, Badurudeen AA, Ramakanth R, Rajasekaran S. Management of Talar Body Fractures. Indian J Orthop. 2018;52(3):258–68.
16. Saravi B, Lang G, Ruff R, Schmal H, Südkamp N, Ülkümen S, et al. Conservative and Surgical Treatment of Talar Fractures : A Systematic Review and Meta-Analysis on Clinical Outcomes and Complications. Int J Env Res Public Heal. 2021;18(16):8274.
17. Ohl X, Harisboure A, Hemery X. Long-term follow-up after surgical treatment of talar fractures. Int Orthop. 2011;35(1):93–9.
18. V JAB, Westermann R, Mooers B, Karam M, Wolf B. Timing of Surgical Reduction and Stabilization of Talus Fracture-Dislocations. Am J Orthop (Belle Mead NJ) [Internet]. 2017;46(6):E408–13. Available from: https://pubmed.ncbi.nlm.nih.gov/29309454/
19. Pflüger P, Zyskowski M, Weber A, Gleisenberg K, Kirchhoff C, Biberthaler P, et al. Patient reported outcome of 33 operatively treated talar fractures. BMC Musculoskelet Disord. 2021;3:1–7.
20. Whitaker C, Turvey B, Illical EM. Current Concepts in Talar Neck Fracture Management. 2018;456–74.
21. Asham LS, Elfadle AA, Badran M, Mohamed AM, Farouk OA. The avascular necrosis after talar neck fractures . Risk factors and Outcomes. 2021;340–5.
22. Sharanappa S, Lal S, Sharma A. A comparative study of three different approaches in treatment of talar neck fractures Journal of Clinical Orthopaedics and Trauma A comparative study of three different approaches in treatment of talar neck fractures. J Clin Orthop Trauma [Internet]. 2022;37(December):102092. Available from: https://doi.org/10.1016/j.jcot.2022.102092
23. Suthar R, Modi H, Dalal B, Trivedi S. A case series : Talus neck fractures treated with open reduction and internal fixation with dual approach- anteromedial and anterolateral. Int J Orthop Sci. 2021;7(4):249–54.
24. García-Rey E, Sanz-Hospital FJ, Galdrán FJ, Cano-Egea JM, Alcázar LFL. Foot and Ankle Surgery Talar neck fractures : results and complications by type 1. Foot Ankle Surg. 2002;8(3).
25. Jordan RK, Bafna KR, Liu J, Ebraheim NA. Complications of Talar Neck Fractures by Hawkins Classification: A Systematic Review. J Foot Ankle Surg. 2017;56(4):817–21.
26. Alton T, Patton DJ, Gee AO. Classifications in Brief: The Hawkins Classification for Talus Fractures. Clin Orthop Relat Res [Internet]. 2015;473(9):3046–9. Available from: http://dx.doi.org/10.1007/s11999-015-4136-x
27. Herrera-p M, Gonz D, Vallejo-m M, Godoy-santos AL, Valderrabano V, Tejero S. Ankle Osteoarthritis Aetiology. J Clin Med. 2021;10(19):4489.
28. Dhillon MS, Rana B, Panda I, Patel S, Kumar P. Management Options in Avascular Necrosis of Talus. Indian J Orthop [Internet]. 2018;52(may):284–96. Available from:
file:///C:/Users/91997/Downloads/IJOrtho-52-284.pdf
29. Sakaki M, Macedo R, Santos A, Ortiz R, Sposeto R. Talar Body Reconstruction for Nonunions and Malunions. Indian J Orthop [Internet]. 2018;52:276–83. Available from:
https://observatorio.fm.usp.br/bitstream/OPI/27009/1/art_SAKAKI_Talar_Body_Reconstruction_for_Nonunions_and_Malunions_2018.PDF
30. Annappa R, Jhamaria NL, Dinesh KVN, Devkant, Ramesh RH, Suresh PK. Functional and radiological outcomes of operative management of displaced talar neck fractures. Foot. 2015;25(3):127–30

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