Vallier Heather A
MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2015 Sep;29(9):385-92. doi: 10.1097/BOT.0000000000000378.
Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits. Delayed definitive fixation may reduce the risks of wound complications and infections. Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. Osteonecrosis is reported in up to half of talar neck fractures, although many of these injuries will revascularize without collapse of the talar dome. Initial fracture displacement and presence of open fractures increase the risk of osteonecrosis. Talar process fractures may be subtle and easily missed on plain radiographs. Advanced imaging will provide detail to facilitate treatment planning.
Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
距骨骨折很少见，但常伴有并发症和功能受限。当相邻软组织损伤允许时，建议对相关脱位进行紧急复位，并对移位骨折进行切开复位内固定。延迟确定性固定可降低伤口并发症和感染的风险。恢复关节和轴向对线对于优化踝关节和后足功能至关重要。尽管如此，距骨颈和体部骨折后创伤性关节炎仍很常见，尤其是距骨体粉碎性骨折。据报道，多达一半的距骨颈骨折会发生骨坏死，尽管其中许多损伤会在距骨穹顶不塌陷的情况下重新血管化。初始骨折移位和开放性骨折的存在会增加骨坏死的风险。距骨突骨折可能很细微，在平片上很容易漏诊。先进的影像学检查将提供详细信息，以方便治疗计划的制定。
治疗性V级。有关证据水平的完整描述，请参阅作者指南。
