Complications and Functional Outcome Following Operative Treatment of Talus Neck and Body Fractures: A Systematic Review

Abstract

Background: Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures, complications rates remain high and functional outcome is generally poor. This study aims to provide an overview of complication rates and functional outcome following operative treatment of talar neck and body fractures. This may help in clinical decision making by improving patients’ expectation management and tailored treatment strategies. Methods: A systematic review of the literature was conducted of studies published from January 2000 to July 2021 reporting functional outcome and/or complications following operative treatment of talar neck, body, or combined neck and body fractures. Keywords used were (Talar fracture) or (Talus fracture). Data on complication rates and functional outcome was extracted from selected articles. Results: A total of 28 articles were included in our analysis reporting 1086 operative treated talar fractures (755 neck [70%], 227 body fractures [21%], and 104 combined body and neck fractures [9%]). The mean follow-up was 48 (range 4-192) months. Complications occurred frequently with; 6% surgical site infection, 8% nonunion, 29% avascular necrosis, 64% osteoarthritis, and in 16% a secondary arthrodesis was necessary. A wide variety in functional outcome was reported; however, there seems to be a correlation between fracture classification and postoperative complications. Conclusion: Operative treatment of central talar fractures is associated with a high incidence of early and late complications and often leads to an impaired functional outcome. Standardization of talar fracture classification and scoring systems in combination with large sample-sized prospective studies are warranted to detect further predictive factors influencing tailormade treatment strategies and patient expectation management. Level of Evidence: Level III, Systematic review of case series and case-control studies.

Talar Neck Fractures with Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis

“…Thirty-seven percent of talar neck fractures in this cohort developed AVN, which is similar to previous systematic reviews reporting rates of AVN between 26% and 33%. 1,9,19 The talus acts as the cornerstone of the ankle joint with articulations between the talar head and the navicular anteriorly, the talar facets and the calcaneus inferiorly, and the talar dome and tibial plafond superiorly. 20 These articulations account for about two-thirds of the articular cartilage located on the surface of the talus, which results in a tenuous arterial blood supply.…”

“…was 13 months (IQR,[8][9][10][11][12][13][14][15][16][17][18][19][20] and was 12 months (IQR,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] in the ITN group (P = 0.984).Ofnote, 21 talar neck fractures (18.3%) were open, with 12 in the TNIFAF group and 9 in the ITN group. All open fractures underwent irrigation and debridement in the ED.…”

Long-Term Outcome Analysis of Surgically Treated Talus Fractures in a Tertiary Care Hospital

“…There was also a correlation between fracture complexity and the incidence of post-traumatic arthritis (90% in the complex fracture group). In a systematic review of 1086 talus neck and body fractures, Wijers et al reported a prevalence of 29% for AVN and 69% for post-traumatic arthritis [ 6 ]. Vints et al conducted a clinical follow-up of 84 patients who had undergone operative fixation of talus fractures for 9.1 years.…”

“…The only identified risk factor for AVN is the degree of initial displacement observed on CT scans and radiographs. Post-traumatic arthritis is a common long-term complication, with incidence rates ranging from 34% to 100% in studies with longer follow-ups [ 6 ].…”