Abdelkafy Ashraf, Imam Mohamed Abdelnabi, Sokkar Sherif, Hirschmann Michael
Consultant and Lecturer, Department of Orthopaedic Surgery and Traumatology, Suez Canal University Faculty of Medicine, Ismailia, Egypt.
Registrar, South West of London Elective Orthopedic Center, London, United Kingdom.
J Foot Ankle Surg. 2015 Jan-Feb;54(1):23-8. doi: 10.1053/j.jfas.2014.09.046. Epub 2014 Nov 1.
The talar neck is deviated medially with reference to the long axis of the body of the talus. In addition, it deviates plantarward. The talar neck fracture line is sometimes observed to be oriented obliquely (not perpendicular to the long axis of the talar neck). This occurs when the medially deviated talar neck strikes the horizontally oriented anterior lower tibial edge. Internal fixation of a simple displaced talar neck fracture usually requires 2 lag screws. Because the fracture line is obliquely oriented, a better method for positioning the screws perpendicular to the fracture line is to place them in a reversed direction to provide maximum interfragmentary compression at the fracture site, which could increase the likelihood of absolute stability with subsequent improvement in the incidence of fracture union and a reduction of complications, such as avascular necrosis of the body of the talus. Two lag screws are used, with the first inserted from posteriorly to anteriorly (perpendicular to the fracture line) using a medial approach after medial malleolar chevron osteotomy. The second screw is inserted from anteriorly to posteriorly (perpendicular to the fracture line) using an anterolateral approach. Both screw heads should be countersunk. A series of 8 patients underwent this form of internal fixation for talar neck fracture repair, with satisfactory functional outcomes. In conclusion, the use of antegrade-retrograde opposing lag screws is a reasonable method of internal fixation for simple displaced talar neck fractures.
距骨颈相对于距骨体的长轴向内偏移。此外，它还向足底方向偏移。有时可观察到距骨颈骨折线呈斜向（不垂直于距骨颈的长轴）。当向内偏移的距骨颈撞击水平方向的胫骨前下缘时就会出现这种情况。单纯移位的距骨颈骨折的内固定通常需要2枚拉力螺钉。由于骨折线呈斜向，将螺钉垂直于骨折线定位的更好方法是反向置入，以在骨折部位提供最大的骨折块间加压，这可能会增加获得绝对稳定性的可能性，进而提高骨折愈合率并减少并发症，如距骨体缺血性坏死。使用2枚拉力螺钉，第一枚在进行内踝V形截骨后，经内侧入路从后向前（垂直于骨折线）插入。第二枚螺钉经前外侧入路从前向后（垂直于骨折线）插入。两枚螺钉的头部均应埋头。一组8例患者接受了这种形式的距骨颈骨折修复内固定术，功能结果令人满意。总之，顺行-逆行相对拉力螺钉的使用是单纯移位距骨颈骨折内固定的一种合理方法。
