Background: The purpose of this retrospective review was to evaluate
the long-term results of surgical treatment of isolated, displaced talar neck
and/or body fractures with stable internal fixation.
Methods: The study included twenty-five patients with a total of
twenty-six displaced fractures isolated to the talus that had been treated
with open reduction and stable internal fixation and followed for a minimum of
forty-eight months after the injury. The final follow-up examination included
standard radiographs, computed tomography, and a clinical evaluation.
Variables that were analyzed included wound type, fracture type, Hawkins type,
comminution, timing of the surgical intervention, surgical approach, quality
of fracture reduction, Hawkins sign, osteonecrosis, union, time to union,
posttraumatic arthritis, and the AOFAS scores including subscores (pain,
function, and alignment).
Results: The average duration of follow-up was seventy-four months.
Surgical intervention resulted in sixteen fractures with an anatomic
reduction, five with a nearly anatomic reduction, and five with a poor
reduction. All eight noncomminuted fractures were anatomically reduced. The
overall union rate was 88%. All closed, displaced talar neck fractures healed,
regardless of the time delay until surgical intervention. Posttraumatic
arthritis of the subtalar joint was the most common finding and was seen in
all patients, sixteen of whom had involvement of more than one joint.
Osteonecrosis was a common finding, seen after thirteen of the twenty-six
fractures overall and after six of the seven open fractures.
Conclusions: Open reduction and internal fixation is recommended for
the treatment of displaced talar neck and/or body fractures. A delay in
surgical fixation does not appear to affect the outcome, union, or prevalence
of osteonecrosis. Posttraumatic arthritis is a more common complication than
osteonecrosis following operative treatment. Patients with a displaced
fracture of the talus should be counseled that posttraumatic arthritis and
chronic pain are expected outcomes even after anatomic reduction and stable
fixation. This is especially true following open fractures.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to authors for a
complete description of levels of evidence.