Fractures of the body of the talus are uncommon and poorly described. The
purposes of the present study were to characterize these fractures, to
describe one treatment approach, and to evaluate the clinical, radiographic,
and functional outcomes of operative treatment.
Fifty-six patients with fifty-seven talar body fractures who had been
treated operatively during a sixty-seven-month period at a level-1 trauma
center were identified with use of a database. Twenty-three patients had a
concomitant talar neck fracture. Eleven of the fifty-seven fractures were
open. All patients underwent open reduction and internal fixation.
Complications, secondary procedures, and the ability to return to work were
evaluated at a minimum of one year. The radiographic presence of osteonecrosis
and posttraumatic arthritis was ascertained. Foot Function Index and
Musculoskeletal Function Assessment questionnaires were completed.
Thirty-eight patients were evaluated after an average duration of follow-up
of thirty-three months. Early complications occurred in eight patients. Ten of
the twenty-six patients who had a complete set of radiographs had development
of osteonecrosis of the talar body. Five of these ten patients experienced
collapse of the talar dome at a mean of 10.2 months after surgery. All
patients with a history of both an open fracture and osteonecrosis experienced
collapse. Seventeen of twenty-six patients had posttraumatic arthritis of the
tibiotalar joint, and nine of twenty-six had posttraumatic arthritis of the
subtalar joint. Fractures of both the talar body and neck led to development
of advanced arthritis more frequently than did fractures of the talar body
only (p = 0.04). All patients with open fractures had end-stage posttraumatic
arthritis (p = 0.053). Twenty-three (88%) of twenty-six patients had
radiographic evidence of osteonecrosis and/or posttraumatic arthritis. Worse
outcomes were noted in association with comminuted and open fractures.
Osteonecrosis and posttraumatic arthritis adversely affected outcome
Open reduction and internal fixation of talar body fractures may restore
congruity of the adjacent joints. However, early complica-tions are not
infrequent, and most patients have development of radiographic evidence of
osteonecrosis and/or posttraumatic arthritis. Associated talar neck fractures
and open fractures more commonly result in osteonecrosis or advanced
arthritis. Worse functional outcomes are seen in association with advanced
posttraumatic arthritis and osteonecrosis that progresses to collapse. It is
important to counsel patients regarding these devastating injuries and their
poor prognosis and potential complications.