Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy.
BMC Musculoskelet Disord. 2019 Aug 7;20(1):363. doi: 10.1186/s12891-019-2738-2.
The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management.
From January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed.
27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49-119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7-7). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0-11 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9-10). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%).
Despite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF.
本回顾性病例系列研究的主要目的是评估通过切开复位内固定（ORIF）治疗的连续系列孤立、移位、闭合距骨颈或体骨折患者的长期影像学和临床结果。其次，目的是验证距骨骨折的位置对结果的影响、Hawkins 征的预后价值、手术延迟是否促进缺血性坏死（AVN）以及骨折是否需要紧急手术治疗。
自 2007 年 1 月至 2012 年 12 月，在我们的机构中，31 名患者通过使用螺钉进行了 ORIF。根据 Inokuchi 标准，损伤分为颈骨折和体骨折，分别根据 Hawkins 和 Sneppen 进行分类。将患者分为与骨折位置和复杂性相关的两组。影像学评估侧重于复位质量、骨愈合、Hawkins 征和创伤后关节炎（PTA）的发展。对于临床评估，确定临床功能评分（AOFAS 踝-后足评分；MFS；FFI-17；SF-36）和 VAS，并进行统计分析。
27 名患者，19 名男性和 8 名女性，平均年龄 38.3 岁，平均随访 83.2 个月（范围 49-119）。有 9 例颈骨折和 19 例体骨折；22 例复位为解剖或近乎解剖，所有病例均在平均 3.4 个月（范围 1.7-7）后达到影像学愈合。9 例出现 Hawkins 征，无坏死发生。手术时间间隔为 0-11 天，超过 60%的患者获得不同评分的良好或中等结果，而 18 例（66.7%）完全满意（VAS：9-10）。早期并发症包括畸形愈合（21.4%）和伤口问题（25%）；晚期并发症包括 AVN（25%）和 PTA（78.6%）。
尽管长期并发症发生率较高，但仍获得了满意的临床结果。距骨骨折的位置并不影响结果，Hawkins 征被证实为一个积极的预后因素，手术时机并不影响 AVN 的发展。因此，这些损伤不需要通过 ORIF 进行紧急手术治疗。
