The treatment of the fractures of the talar neck / 中华骨科杂志

ABSTRACT

Objective To study the characteristics and classifications of the fractures of the talar neck as well as to define the appropriate treatments and its complications. Methods 47 patients of the fractures of the talar neck were referred to our department of orthopaedics from July 1996 to November 2001. There were 32 males and 15 females with an average age of 31.6 years. The injuries were caused by fall in 13, traffic accident in 28, and others in 6. According to Hawkins classification, there were type Ⅰwith nondisplaced vertical fracture in 6 patients, which were treated non-operatively, and immobilized with a non weight bearing short leg cast; type Ⅱ in 26 patients, and type Ⅲ in 15 patients, all of which were treated in emergency with anatomic reduction and fixation with 4.0 mm lag screws through anteromedial or anterolateral approaches of the ankle. Otherwise, the arthrodesis of subtalar joint in type Ⅲ fracture were primarily performed as well. The ankles were immobilized until the fracture healed. Results The patients were followed up 2 to 5 years (average, 3.6 years). By the assessment of clinical effects depending on the complaints, functions and radiological results of the ankle and subtalar joint, 17 patients were rated as excellent, 22 patients good, 5 fair, and 1 poor, the total rate of excellent and good was 83.0%. Osteonecrosis occurred in 8 patients with 3 of type Ⅱ and 5 of type Ⅲ fractures. 3 of 4 patients with talar displacement were found with osteonecrosis or painful arthritis. The subtalar arthrosis occurred in 6 patients, 4 of which were associated with ankle arthrosis. 3 patients underwent arthrodesis because of painful arthritis of the subtalar joint or osteonecrosis of the talar body. Anteromedial skin necrosis of the ankle developed in 1 patient. Conclusion If the fracture of talar neck is not managed appropriately as early as possible, its complications are common, the fractures should be treated in emergency to reduce the incidence of posttraumatic osteonecrosis, arthrosis and malunion of the fractures.