J Korean Fract Soc.  2015 Oct;28(4):215-222. 10.12671/jkfs.2015.28.4.215.

The Result of Open Reduction and Mini-Plate Fixation for Displaced Talar Neck Fracture

• Na WC
• Lee SH
• Lee JY
• Lee SJ
• Kim B

• KMID: 2070347
• DOI: http://doi.org/10.12671/jkfs.2015.28.4.215

Abstract

PURPOSE
We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures.
MATERIALS AND METHODS
There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin's classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.
RESULTS
Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin's classification and union rates and clinical results.
CONCLUSION
Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

Keyword

Talar neck; Displaced fracture; Mini-plate

MeSH Terms

Ankle
Arthritis
Classification
Follow-Up Studies
Foot
Humans
Magnetic Resonance Imaging
Neck*
Necrosis
Retrospective Studies

Figure

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  Fig. 1 Intraoperative photograph shows fracture site exposure by medial malleolar osteotomy and fixation using a mini-plate on the superior portion of the deltoid ligament attachment site.

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  Fig. 2 (A-D) The preoperative simple radiographs and 3-dimensional computed tomography show a Hawkin's type III comminuted talar neck fracture. (E-G) Comminuted talar neck fracture was fixed by a miniplate and medial malleolar osteotomy was fixed by a 4.0 cannulated screw.

Reference

1. Baumhauer JF, Alvarez RG. Controversies in treating talus fractures. Orthop Clin North Am. 1995; 26:335–351.

2. Halvorson JJ, Winter SB, Teasdall RD, Scott AT. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg. 2013; 52:56–61.

3. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970; 52:991–1002.

4. Kenwright J, Taylor RG. Major injuries of the talus. J Bone Joint Surg Br. 1970; 52:36–48.

5. Canale ST. Fractures of the neck of the talus. Orthopedics. 1990; 13:1105–1115.

6. Grob D, Simpson LA, Weber BG, Bray T. Operative treatment of displaced talus fractures. Clin Orthop Relat Res. 1985; (199):88–96.

7. Lorentzen JE, Christensen SB, Krogsoe O, Sneppen O. Fractures of the neck of the talus. Acta Orthop Scand. 1977; 48:115–120.

8. Cronier P, Talha A, Massin P. Central talar fractures--therapeutic considerations. Injury. 2004; 35:Suppl 2. SB10–SB22.

9. Sangeorzan BJ, Wagner UA, Harrington RM, Tencer AF. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res. 1992; 10:544–551.

10. Ohl X, Harisboure A, Hemery X, Dehoux E. Long-term follow-up after surgical treatment of talar fractures: twenty cases with an average follow-up of 7.5 years. Int Orthop. 2011; 35:93–99.

11. Penny JN, Davis LA. Fractures and fracture-dislocations of the neck of the talus. J Trauma. 1980; 20:1029–1037.

12. Gelberman RH, Mortensen WW. The arterial anatomy of the talus. Foot Ankle. 1983; 4:64–72.

13. Peterson L, Goldie IF. The arterial supply of the talus. A study on the relationship to experimental talar fractures. Acta Orthop Scand. 1975; 46:1026–1034.

14. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978; 60:143–156.

15. Daniels TR, Smith JW. Talar neck fractures. Foot Ankle. 1993; 14:225–234.

16. Fleuriau Chateau PB, Brokaw DS, Jelen BA, Scheid DK, Weber TG. Plate fixation of talar neck fractures: preliminary review of a new technique in twenty-three patients. J Orthop Trauma. 2002; 16:213–219.

17. Frawley PA, Hart JA, Young DA. Treatment outcome of major fractures of the talus. Foot Ankle Int. 1995; 16:339–345.

18. Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD. Functional outcomes following displaced talar neck fractures. J Orthop Trauma. 2004; 18:265–270.

19. Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am. 2004; 86:1616–1624.

20. Fortin PT, Balazsy JE. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001; 9:114–127.

21. Attiah M, Sanders DW, Valdivia G, et al. Comminuted talar neck fractures: a mechanical comparison of fixation techniques. J Orthop Trauma. 2007; 21:47–51.

22. Rammelt S, Zwipp H. Talar neck and body fractures. Injury. 2009; 40:120–135.

23. Swanson TV, Bray TJ, Holmes GB Jr. Fractures of the talar neck. A mechanical study of fixation. J Bone Joint Surg Am. 1992; 74:544–551.

24. Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin. 2004; 9:723–736. vi.

25. Xue Y, Zhang H, Pei F, et al. Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. Int Orthop. 2014; 38:149–154.

26. Daniels TR, Smith JW, Ross TI. Varus malalignment of the talar neck. Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am. 1996; 78:1559–1567.