Saudan M, Peter R, Delmi M
Clinique et Policlinique d'Orthopédie et Chirurgie de l'Appareil locomoteur, Hôpital Cantonal Universitaire de Genève, 24, rue Micheli-du-Crest, 1211 Genève 14, Suisse.
Rev Chir Orthop Reparatrice Appar Mot. 2002 Apr;88(2):168-76.
Complication rate is high after talar neck fractures. Avascular osteonecrosis and post-traumatic joint degeneration could be avoided by proper management. We analyzed long-term outcome in a series of 40 talar neck fractures treated in our unit from 1979 to 1995.
Mean follow-up was 9 years. Orthopedic and surgical management by Hawkins classification group was, respectively, type I=10 (7 and 3), type II=17 (3 and 14), type III=11 (1 and 10) and type IV=2 (both surgery). Two patients had bilateral fractures and 7 fractures were open. Among the 29 fractures treated surgically, the anteromedial approach was used for open reduction and fixation for 18. A dual approach was needed for 1 patient with a type III fracture. Fixation was achieved with cancelous screws for 17/29 fractures including 3 fluted screw fixations, cortical screws for 9, K-wires for 2 and staples for 1.
According to the AOFAS classification, mean function score at last follow-up was 94.4/100 for type I, 78.5 for type II, 69.5 for type III, and 57.5 for type IV. Signs of osteoarthritis were observed in 68% of the cases with clinical expression in 9 out of 10 cases.
The results show that conservative treatment is indicated for type I fractures while open reduction and fixation should be used for types II, III, and IV. Subsequent joint degeneration was correlated with the type of fracture and clearly influenced functional outcome. In our long-term follow-up, we only had two cases of osteonecrosis which finally necessitated arthrodesis. This low rate would be related to the fact that most of the patients were able to avoid weight bearing for several months.
