Talar Fractures: Results and Outcomes

Karthick Hunse^*, Dr Shantharam Shetty¹, Dr Ajith Kumar M²

*Correspondence to: Karthick Hunse, India.

Copyright
© 2024 Karthick Hunse. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 01 Oct 2024

      Published: 01 Nov 2024

   DOI: https://doi.org/10.5281/zenodo.14051222

Abstract

BACKGROUND: Talar fractures occur infrequently and have been associated with high complication rates. The purpose of our present study were to evaluate the rates of early and late complications after operative treatment of talar fractures, to ascertain the effect of surgical delay on the development of osteonecrosis, and to determine the functional outcomes after operative treatment of such fractures.

METHODS:   We retrospectively reviewed the records of 78  with 60 males  and 18 female patients with talar fractures who were managed at  Tejasvini Hospital and SSIOT from 2004 to 2010.  Amon g these patients   5(3.9%) had fracture of the body of talus, 55(42.9%) had fracture neck of the talus, 6 (4.68%) had fracture of the head of the talus, and 12 had dislocations in 12 (9.36%) of the 78 patients.All fractures have been treated with open reduction and internal fixation. 78  fractures were evaluated  during this period after surgery. Complications  with radiographic evidence of osteonecrosis and posttraumatic arthritis was evaluated.  The results were evaluated using Hawkin’s Criteria.

RESULTS:  Radiographic evidence of osteonecrosis was seen in  20 (25.64%),  with joint stiffness in 53 (67.94%), peritalar arthritis in 32(41.02%), malunion in 17(21.79%), and infection in 8 (10.25%) of the 78 patients  studied.

 The mean time to fixation was 3.6 days  for patients who had development of osteonecrosis, compared with 6 days for the patients who did not  have development of osteonecrosis. With  the numbers available, no correlation could be identified between surgical delay and the development of osteonecrosis. Osteonecrosis was associated with communition of the talar neck fractures and open fractures. 32 Patients  had development of posttraumatic arthritis, which was more common after communited fractures and open fractures. Patients  with communited fractures also had worse functional outcome scores.

CONCLUSIONS: Fractures of the talus are associated with high rates of morbidity and complications . although the numbers in the present series were small, no correlation was found between the timing of fixation and the development of the osteonecrosis. Osteonecrosis was associated with talar neck fractures, and more with communited and open type of  fractures, confirming the that higher energy injuries are associated with more complications and worse prognosis. These findings were strengthened by evaluating  using Hawkin’s criteria  in these patients. And we recommend urgent reduction and treatment of these dislocations and fractures. And definitive rigid internal fixation of the talar neck fractures after soft tissue swelling has subsided which may minimize further soft tissue complications.

Background

Talar fractures occur infrequently.  Such fractures are a result of high energy trauma and are characterised by displacement , communition, and sot tissue injury which has an impact on the treatment and outcome. Urgent reduction of these fractures have been advocated to protect any remaining blood supply to the talar body and to promote revascularisation  (1, 2)

The blood supply to the talus has been well characterised (1, 2) primarily localised to the talar neck and medial part of the talar body. These fractures often disrupt the congruity of the peritalar joints (3, 4). Restoration and preservation of the anatomic alignment may limit the development of  posttraumatic arthritis. Which  have a devastating impact on the overall outcome. The purpose of our present study is to evaluate the complications of the talar ffactures and to the present the outcome after surgical intervention.

Materials and Methods

We retrospectively reviewed the records of 78  with 60 males  and 18 female patients with talar fractures who were managed at  Tejasvini Hospital and SSIOT from 2004 to 2010.  Among these patients   5(3.9%) had fracture of the body of talus, 55(42.9%) had fracture neck of the talus, 6 (4.68%) had fracture of the head of the talus, and 12 had dislocations in 12 (9.36%) of the 78 patients.All fractures have been treated with open reduction and internal fixation. 78  fractures were evaluated  during this period after surgery. Complications  with radiographic evidence of osteonecrosis and posttraumatic arthritis was evaluated.  The results were evaluated using Hawkin’s Criteria.

These fractures were  treated with open reduction and internal fixation with cannulated cancellous screw fixation. Using anteromedial or anterolateral approach with 10 patients requiring medial malleolar osteotomy for better visualisationa dn reduction. Postoperatively manged with casting for  6 weeks and mobilisaed according to the fracture healing as indicated by the radiographic evidence.

C T Scan was used in cases of  communited fractures of talus but not regulary. Osteonecrosis was defined as on plain radiograph as any area of increased density of the talar dome relative to the adjacent  structures. posttraumatic arthritis was defined as any loss of joint space., formation of osteophytes  or development of subchondral cysts or sclerosis.

Results

Radiographic evidence of osteonecrosis was seen in  20 (25.64%),  with joint stiffness in 53 (67.94%), peritalar arthritis in 32(41.02%), malunion in 17(21.79%), and infection in 8 (10.25%) of the 78 patients  studied5.

The mean time to fixation was 3.6 days  for patients who had development of osteonecrosis, compared with 6 days for the patients who did not  have development of osteonecrosis. With  the numbers available, no correlation could be identified between surgical delay and the development of osteonecrosis. Osteonecrosis was associated with communition of the talar neck fractures and open fractures. 32 Patients  had development of posttraumatic arthritis, which was more common after communited fractures and open fractures. Patients  with communited fractures also had worse functional outcome scores.

In conclusion, it has been suggested that early operative intervention protects the already tenous blood supply to the  talus. Athough the numbers in the series are small, no correlation was found between the timing of fixation and the development of ostenecrosis. With this study we recommend urgent  treatment  and reduction of dislocations  and proceeding with definitive fixation when there is minimal soft tissue swelling to promote fracture healing and early mobilisation status to the patient.

References

1. Gelberman  R H, Foot Ankle 1983: 4:64-72

2. Mulfinger GL, the blood supply of talus JBJS 1970:52:160-7

3. Daniels T R, varus malalignment of the talar neck. JBJS Am.1996:78:1559-67

4. Sangeorzan BJ, contact characteristics of subtalar joint:the effect of talat neck misalignment. J Orthop Res.1992:10:544-51

5. Heather A.Vallier, J bone Joint Surg Am.2004:86:1616-1624