Session II Foot and Ankle

Displaced Fractures of the Neck of the Talus Treated by Emergent ORIF Using a Two Incision Approach

Gary Rosenberg, MD, Brendan Patterson, MD, John Wilber, MD, John Sontich, MD

Case Western Reserve University, MetroHealth Medical Center,Cleveland, Ohio

Hypothesis: Displaced fractures of the neck of the talus treated by emergent ORIF using a two incision approach results in a lower incidence of avascular necrosis than other reported series in the literature.

Conclusion: There is a lower rate of avascular necrosis in displaced talar neck fractures treated by emergent ORIF using a two incision approach.

Material and Methods: A retrospective review was undertaken of all Hawkin's type II, Ill and IV talar neck fractures treated at our institution between April 1989 and November 1995. All patients were treated with a standard treatment protocol of immediate rigid internal fixation using an anteromedial and anterolateral surgical approach. All patients were allowed to fully weight-bear at three months post-operatively. Data collected included time from injury to the operating room, Hawkin's classification of the injury, radiographic evidence of AVN and/or collapse, and radiographic evidence of tibiotalar/subtalar arthritis. Patients were evaluated with the clinical rating system for the ankle-hindfoot developed by the American Orthopaedic Foot and Ankle Society.

Results: Twenty-one displaced fractures of the talar neck were retrospectively reviewed for this study. There were 10 Hawkin II's, 9 Hawkin III's, and 2 Hawkin IV displaced talar neck fractures. There were four open fractures (Type II: 2, Type lIlA: 2). The average time from injury to the operating room was 6.5 hours. The average length of follow-up was 2.2 years. The average age of the patients was 36 years. Of the twenty-one patients studied two developed radiographic evidence of avascular necrosis at follow-up and one of these patients went on to develop collapse of the talar body. This patient was transferred to our institution and definitive treatment of his talar neck fracture was not performed until 23 hours after injury. Two patients had mild evidence of tibiotalar/subtalar arthritis and one developed severe tibiotalar/subtalar arthritis. Fifteen of twenty-one patients showed a decrease in subtalar range of motion. The remainder of the patients had normal radiographs at latest follow-up.