Department of Orthopaedic Surgery, University of Miami, Miami, FL.
Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY.
J Orthop Trauma. 2024 Jun 1;38(6):220-224. doi: 10.1097/BOT.0000000000002798.
To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared with isolated talar neck fractures (ITNs).
Retrospective cohort.
Single level I trauma center.
Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least 6-month follow-up. Based on radiographs at the time of injury, fractures were classified as ITN or TNIFAF and by Hawkins classification.
The primary outcome was the development of AVN based on follow-up radiographs, with secondary outcomes including nonunion and collapse.
There were 115 patients who sustained talar neck fractures, with 63 (55%) in the ITN group and 52 (45%) in the TNIFAF group. In total, 63 patients (54.7%) were female with the mean age of 39 years (range, 17-85), and 111 fractures (96.5%) occurred secondary to high-energy mechanisms of injury. There were no significant differences in demographic or clinical characteristics between groups ( P > 0.05). Twenty-four patients (46%) developed AVN in the TNIFAF group compared with 19 patients (30%) in the ITN group ( P = 0.078). After adjusting for Hawkins classification and other variables, the odds of developing AVN was higher in the TNIFAF group compared with the ITN group [odds ratio, 2.43 (95% confidence interval, 1.01-5.84); ( P = 0.047)].
This study found a significantly higher likelihood of AVN in patients with talar neck fractures with concomitant ipsilateral foot and/or ankle fractures compared to those with isolated talar neck fractures after adjusting for Hawkins classification and other potential prognostic confounders.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定伴有同侧足部和/或踝关节骨折的距骨颈骨折（TNIFAF）与单纯距骨颈骨折（ITN）相比，是否更易发生缺血性坏死（AVN）。
回顾性队列研究。
单一级创伤中心。
2008 年 1 月至 2017 年 1 月期间，骨骼成熟的距骨颈骨折患者，至少随访 6 个月。根据受伤时的 X 线片，骨折分为 ITN 或 TNIFAF，并按 Hawkins 分类。
主要结果是根据随访 X 线片确定的 AVN 发生情况，次要结果包括不愈合和塌陷。
共有 115 例患者发生距骨颈骨折，其中 ITN 组 63 例（55%），TNIFAF 组 52 例（45%）。共 63 例（54.7%）为女性，平均年龄 39 岁（范围 17-85 岁），111 例（96.5%）骨折继发于高能损伤机制。两组间在人口统计学和临床特征方面无显著差异（P＞0.05）。TNIFAF 组 24 例（46%）发生 AVN，ITN 组 19 例（30%）（P=0.078）。在调整 Hawkins 分类和其他变量后，与 ITN 组相比，TNIFAF 组发生 AVN 的可能性更高[比值比，2.43（95%置信区间，1.01-5.84）；（P=0.047)]。
本研究发现，在调整 Hawkins 分类和其他潜在预后混杂因素后，与单纯距骨颈骨折相比，伴有同侧足部和/或踝关节骨折的距骨颈骨折患者发生 AVN 的可能性显著更高。
预后 III 级。请参阅作者指南，以获取完整的证据水平描述。
