Bastos Leonardo Ribeiro, Ferreira Ricardo Cardenuto, Mercadante Marcelo Tomanik
MSc in Medicine; Orthopedist and Specialist in Foot and Ankle Surgery; First Medical Lieutenant of the Brazilian Army, serving at the Central Hospital of the Army.
PhD in Medicine; Assistant Professor and Head of the Foot and Ankle Surgery Group, Department of Orthopedics and Traumatology, Santa Casa de Sao Paulo.
Rev Bras Ortop. 2015 Nov 17;45(4):362-74. doi: 10.1016/S2255-4971(15)30382-7. eCollection 2010 Jul-Aug.
To evaluate the clinical, functional and radiographic results from talar neck fractures in patients treated at the Foot and Ankle Surgery Group of Santa Casa de Sao Paulo.
We evaluated 20 patients. The mean follow-up time was 71 months. One fracture was classified as Hawkins Type I, 12 as Hawkins type II, five as Hawkins type III, two as Hawkins type IV and four fractures were open.
One patient was treated conservatively, 16 were treated with open reduction and internal fixation (three with primary subtalar arthrodesis), one was treated with talectomy and two with tibiotalocalcaneal arthrodesis. The reduction obtained was anatomical in seven feet, acceptable in six feet and poor in four. Seven patients had early complications. There was one case of delayed consolidation and four of talar body osteonecrosis. Four patients required secondary reconstruction procedures. No significant radiographic impairment of the ankle joint was found in 62% of the patients and of the subtalar joint in 25%. Of the patients who did not undergo secondary procedures, 81% complained about the treated foot, 37.5% showed some deformity, 44% presented diminished sensitivity and 50% had to retire from work. The mean loss of motion in the ankle was 49%, and in the subtalar joint, 80%. The average AOFAS score was 73 points.
Talar neck fractures are associated with high rates of clinical, functional and radiographic complications.
评估圣保罗圣卡塔琳娜医院足踝外科组治疗的距骨颈骨折患者的临床、功能和影像学结果。
我们评估了20例患者。平均随访时间为71个月。1例骨折分类为霍金斯I型，12例为霍金斯II型，5例为霍金斯III型，2例为霍金斯IV型，4例骨折为开放性骨折。
1例患者接受保守治疗，16例接受切开复位内固定治疗（3例行一期距下关节融合术），1例接受距骨切除术，2例接受胫距跟关节融合术。7例足部复位达到解剖复位，6例可接受，4例较差。7例患者出现早期并发症。有1例延迟愈合和4例距骨体骨坏死。4例患者需要二次重建手术。62%的患者踝关节未发现明显影像学损伤，25%的患者距下关节未发现明显影像学损伤。在未接受二次手术的患者中，81%对治疗的足部不满意，37.5%有一定畸形，44%感觉减退，50%不得不退休。踝关节平均活动度丧失49%，距下关节平均活动度丧失80%。美国足踝外科协会（AOFAS）平均评分为73分。
距骨颈骨折与较高的临床、功能和影像学并发症发生率相关。
