Management of fracture of neck talus and clinical evaluation of results

Abstract

INTRODUCTIONOnly 2% of all lower extremity injuries and 5%-7% of foot injuries involve fracture of talus.1 Talus is second most commonly fractured tarsal bone after calcaneus. 2 Fracture and dislocations of talus are infrequently encountered injuries; but are challenging injuries. So also, scarce evidence is available in the literature on these fractures and its management. Overall talus neck fracture account for 50% of these injuries. Many controversies surround the treatment of talus neck fracture which reflects the difficulty of assessment, surgical approach, fixation method and frequency of post-op complications. 2 ABSTRACTBackground: Fracture of neck of talus is rare and serious injury with significant complication rate. The talus is involved in about 2% of all lower extremity injuries and about 5-7% of foot injuries. Talus neck fixation is associated with serious complications such as stiffness at ankle and subtler joint, AVN of body of talus, ankle arthritis and later on subtalar arthritis. The objective was to study and evaluate the operative treatment for talus neck fracture. Methods: All adult patients with talus neck fracture admitted in government medical college and hospital, Latur, Maharashtra, India from January 2006 to December 2015 were involved. There were 15 patients with 10 males and 05 females. Fractures were classified as per Hawkins classification and were treated with closed/open reduction and internal fixation with CC screws. Results: All patients were followed prospectively post operatively and clinical and radiological evaluation was done. Results were analyzed. We noted skin complications in 02 patients and rate of consolidation was 60-70%. The final follow-up examination included determination of the AHS score (ankle-hind foot scale) from the American orthopaedic foot and ankle society (AOFAS), range of motion evaluation and radiological analysis. Conclusions: Displaced talar neck fractures are a therapeutic challenge which has significant early and late complications. Despite of all excellent management, non-union rate in type III, and type IV Hawkins fracture is 85%; and AVN of body of talus is 90-95% due to inherent complications of cut off of blood supply which comes from talar neck. Types II, III, IV were associated with talar body dislocation which caused excessive pressure on soft tissues having significant soft tissue complications. Early anatomical reduction and stable fixation is of vital importance to achieve successful outcome.