Lindvall Eric, Haidukewych George, DiPasquale Thomas, Herscovici Dolfi, Sanders Roy
Orthopaedic Trauma Service, Florida Orthopaedic Institute, 4 Columbia Drive, Suite 710, Tampa, FL 33606, USA.
J Bone Joint Surg Am. 2004 Oct;86(10):2229-34. doi: 10.2106/00004623-200410000-00014.
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.
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).
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.
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.
本回顾性研究的目的是评估采用稳定内固定手术治疗孤立性、移位距骨颈和/或距骨体骨折的长期疗效。
本研究纳入25例患者，共26例孤立性距骨移位骨折，均接受切开复位及稳定内固定治疗，伤后至少随访48个月。末次随访检查包括标准X线片、计算机断层扫描及临床评估。分析的变量包括伤口类型、骨折类型、霍金斯分型、粉碎程度、手术干预时机、手术入路、骨折复位质量、霍金斯征、骨坏死、愈合情况、愈合时间、创伤后关节炎以及美国足踝外科协会（AOFAS）评分及其分项评分（疼痛、功能及对线）。
平均随访时间为74个月。手术干预后，16例骨折达到解剖复位，5例接近解剖复位，5例复位不佳。所有8例无粉碎的骨折均达到解剖复位。总体愈合率为88%。所有闭合性、移位距骨颈骨折均愈合，无论手术干预延迟时间多久。距下关节创伤后关节炎是最常见的表现，所有患者均有此表现，其中16例累及不止一个关节。骨坏死很常见，26例骨折中有13例出现骨坏死，7例开放性骨折中有6例出现骨坏死。
对于移位距骨颈和/或距骨体骨折，建议采用切开复位内固定治疗。手术固定延迟似乎不影响骨折愈合、骨坏死发生率或预后。手术治疗后，创伤后关节炎是比骨坏死更常见的并发症。应告知距骨移位骨折患者，即使骨折达到解剖复位并采用稳定固定，创伤后关节炎和慢性疼痛仍可能出现。开放性骨折后尤其如此。
