Clinical and surgical outcome following surgical management of talar neck fractures

Abstract

Fractures of the talar neck & body remain a challenge to the treating surgeon due to the serious nature of the injury and to the potential complications of the treatment. Displaced fracture of the talar neck is associated with a high percentage of permanent disability. The key for the treatment of talus fracture is knowledge of anatomy and the blood supply Aim of the Study: The aim of the study was to analyze Incidence, age, sex, mechanism of injury, Types of fractures and dislocations, Effectiveness of different methods of fixation, period for union of fractures, complications and their management, Functional outcome. Clinical Material and Methods: Forty two patients were treated for fracture of talar neck at our institution. This study was conducted retrospectively and prospectively Fractures were classified according to HAWKIN'S classification with modification from S. Terry Canale. Three of them belong to type one (undisplaced); eighteen were type 2; nineteen were type 3; two type 4. The compound factures were classified according to Gustillo and Anderson. Road traffic accident was the cause of trauma in twenty two, fall from height being cause of injury in nineteen, one patient had fall of stone slab on the foot. Treatment: Forty patients underwent surgery for the fixation of talar neck fractures. Thirty four of the fractures were operated with in twenty four hours after injury of the 40 patients who underwent fixation, open reduction and internal fixation was done in thirty two patients (seventeen type 3, twelve type 2, two type 4, one type 1). Cannulated /cancellous screws were used to fix talus in seventeen patients (16 antegrade, anteromedial to posterolateral. One posterolateral to anteromedial), Orthofix pins were used in eleven patients, K-wire used in twelve of them. All the fractures were evaluated at the end of six weeks after surgery. Plaster cast removed and radiological evaluation of the fracture was done and below knee cast re applied. In the evidence of fracture union active mobilisation started with strict non weight bearing continued until sound fracture union. Conclusion: Clinical management of the talar neck fractures is complex. Prompt and precise anatomic surgical reduction, preservation of the blood supply, bone grafting of the medial neck comminution, rigid internal fixation to allow joint mobilization post operatively are the guidelines to be followed to reduce poor outcomes.