Session IX - Foot & Ankle

Talus Fractures: Experience of Two Level I Trauma Centers

Hossein Elgafy, MD, FRCS (Ed); Nabil A. Ebraheim, MD; Marvin Tile, MD, FRCS(C); David Stephen, MD, FRCS(C); Jonathan Kase, BS, Medical College of Ohio,Toledo, OH and Sunnybrook and Women's College Health Sciences Center, Toronto, Ontario, Canada

Introduction: A retrospective study was undertaken to assess the outcome in all patients with talus fractures admitted to 2 level I trauma centers between 1992 and 1997.

Methods: The records of 58 patients with 60 talar fractures were retrospectively reviewed. The clinical evaluation was done using 3 different rating systems: American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score (100 points; excellent 90-100, good 75-89, fair 50-47, failure <50); Maryland Foot Score (100 points; excellent 90-100, good 75-89, fair 50-47, failure <50) and Hawkins Evaluation Criteria (15 points; excellent 13-15, good 10-12, fair 7-9, failure 6 or less). The assessment involved review of the plain radiographs, computed tomography scans, and magnetic resonance images.

Results: There were 39 men and 19 women with an average age of 32 (range, 14-74). Eighty six percent of the patients had multiple injuries. The most common mechanism of injury was a motor vehicle accident. The side of the fracture was right in 37 and left in 23. Twenty-seven (45%) of the fractures were neck, 22 (36.7%) process, and 11(18.3 %) body. Forty-eight fractures had operative treatment and 12 were managed conservatively. The average follow-up period was 30 months (range, 24-65). Thirty-two fracture patients (53.3%) developed subtalar arthritis. Two patients had subsequent subtalar fusion. Fifteen fracture patients (25%) developed ankle arthritis. None of these patients required ankle fusion. Fractures of the body of the talus were associated with the highest incidence of degenerative joint disease of both the subtalar and ankle joints. Ten fractures (16.6 %) developed avascular necrosis (AVN); only one patient had subsequent slight collapse. Avascular necrosis occurred mostly after Hawkins Type 3 and 2 fracture neck. Four cases had infection (6.6%); 3 of them were compound fractures. One case with comminuted neck fracture developed talar shortening with cavovarus deformity and required triple fusion.

The outcome was different with each of the 3 rating systems. However, the outcome with the AOFAS Ankle-Hindfoot Score and Hawkins Evaluation Criteria were almost equivalent. Assessment with the 3 rating scores showed that the process fractures had the best results followed by the neck and then the body fractures.

Conclusion: The results of this study showed that fractures of the body of the talus were associated with the highest incidence of degenerative joint disease of both the subtalar and ankle joints. The low incidence of AVN in the current study has been attributed to early anatomical reduction and stabilization of the fracture. The outcome was different with every rating system.