Sage Journals: Discover world-class research

Abstract

Background:

The objective of this study was to determine whether talar neck fractures with proximal extension (TNPE) into the talar body are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck (TN) fractures.

Methods:

A retrospective review of patients sustaining talar neck fractures at a level I trauma center from 2008 to 2016 was performed. Demographic and clinical data were collected from the electronic medical record. Fractures were characterized as TN or TNPE based on initial radiographs. TNPE was defined as a fracture that originates on the talar neck and extends proximal to a line subtended from the junction of the neck and the articular cartilage dorsal to the anterior portion of the lateral process of the talus. Fractures were classified according to the modified Hawkins classification for analysis. The primary outcome was the development of AVN. Secondary outcomes included nonunion and collapse. These were measured on postoperative radiographs.

Results:

There were 137 fractures in 130 patients, with 80 (58%) fractures in the TN group and 57 (42%) in the TNPE group. Median follow-up was 10 months (interquartile range, 6-18 months). The TNPE group was more likely to develop AVN as compared to the TN group (49% vs 19%, P < .001). Similarly, the TNPE group had a higher rate of collapse (14% vs 4%, P = .03) and nonunion (26% vs 9%, P = .01). Even after adjusting for open fracture, Hawkins fracture type, smoking, and diabetes, AVN still remained significant for the TNPE group as compared to the TN group with an odds ratio of 3.47 (95% CI, 1.51-7.99).

Conclusion:

We found a higher rate of AVN, subsequent collapse, and nonunion in patients with TNPE compared to isolated TN fractures.

Level of Evidence:

Level III, retrospective cohort study.

Keywords

talar neck fracture fracture extension talar body fracture avascular necrosis collapse nonunion Hawkins classification

Get full access to this article

View all access options for this article.

References

Adelaar

Madrian

. Avascular necrosis of the talus. Orthop Clin North Am. 2004;35(3):383-395, xi. doi:10.1016/j.ocl.2004.02.010

Berlet

Lee

Massa

. Talar neck fractures. Orthop Clin North Am. 2001;32(1):53-64. doi:10.1016/s0030-5898(05)70193-0

Buza

3rd Leucht

. Fractures of the talus: current concepts and new developments. Foot Ankle Surg. 2018;24(4):282-290. doi:10.1016/j.fas.2017.04.008

Canale

Kelly

Jr.

Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978;60(2):143-156.

Clare

Maloney

. Prevention of avascular necrosis with fractures of the talar neck. Foot Ankle Clin. 2019;24(1):47-56. doi:10.1016/j.fcl.2018.09.003

Elgafy

Ebraheim

Tile

Stephen

Kase

. Fractures of the talus: experience of two level 1 trauma centers. Foot Ankle Int. 2000;21(12):1023-1029. doi:10.1177/107110070002101208

Fleuriau Chateau

Brokaw

Jelen

Scheid

Weber

. Plate fixation of talar neck fractures: preliminary review of a new technique in twenty-three patients. J Orthop Trauma. 2002;16(4):213-219. doi:10.1097/00005131-200204000-00001

Fortin

Balazsy

. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001;9(2):114-127. doi:10.5435/00124635-200103000-00005

Haliburton

Sullivan

Kelly

Peterson

. The extra-osseous and intra-osseous blood supply of the talus. J Bone Joint Surg Am. 1958;40-a(5):1115-1120.

10.

Halvorson

Winter

Teasdall

Scott

. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg. 2013;52(1):56-61. doi:10.1053/j.jfas.2012.10.008

11.

Hawkins

. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991-1002.

12.

Inokuchi

Ogawa

Usami

. Classification of fractures of the talus: clear differentiation between neck and body fractures. Foot Ankle Int. 1996;17(12):748-750. doi:10.1177/107110079601701206

13.

Jordan

Bafna

Liu

Ebraheim

. Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg. 2017;56(4):817-821. doi:10.1053/j.jfas.2017.04.013

14.

Landy

Utset-Ward

Lee

. What are the implications of alternative alpha thresholds for hypothesis testing in orthopaedics? Clin Orthop Relat Res. 2019;477(10):2358-2363. doi:10.1097/CORR.0000000000000843

15.

Large

Adams

Loeffler

Gardner

. Posttraumatic avascular necrosis after proximal femur, proximal humerus, talar neck, and scaphoid fractures. J Am Acad Orthop Surg. 2019;27(21):794-805. doi:10.5435/jaaos-d-18-00225

16.

Lee

Brodke

Perdue

Jr Patel

. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2020;28(20):e878-e887. doi:10.5435/jaaos-d-20-00116

17.

Lindvall

Haidukewych

DiPasquale

Herscovici

Jr Sanders

. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004;86(10):2229-2234. doi:10.2106/00004623-200410000-00014

18.

Miller

Prasarn

Dyke

Helfet

Lorich

. Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am. 2011;93(12):1116-1121. doi:10.2106/jbjs.J.00693

19.

Mulfinger

Trueta

. The blood supply of the talus. J Bone Joint Surg Br. 1970;52(1):160-167.

20.

Oppermann

Franzen

Spies

, et al. The microvascular anatomy of the talus: a plastination study on the influence of total ankle replacement. Surg Radiol Anat. 2014;36(5):487-494. doi:10.1007/s00276-013-1219-9

21.

Parekh

Kadakia

. Avascular necrosis of the talus. J Am Acad Orthop Surg. 2021;29(6):e267-e278. doi:10.5435/jaaos-d-20-00418

22.

Vallier

. Fractures of the talus: state of the art. J Orthop Trauma. 2015;29(9):385-392. doi:10.1097/bot.0000000000000378

23.

Vallier

Nork

Barei

Benirschke

Sangeorzan

. Talar neck fractures: results and outcomes. J Bone Joint Surg Am. 2004;86(8):1616-1624.

24.

Vallier

Nork

Benirschke

Sangeorzan

. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003;85(9):1716-1724. doi:10.2106/00004623-200309000-00010

25.

Vallier

Reichard

Boyd

Moore

. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014;96(3):192-197. doi:10.2106/jbjs.L.01680

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.47 MB

Association of Talar Neck Fractures With Body Extension and Risk of Avascular Necrosis

Abstract

Background:

Methods:

Results:

Conclusion:

Level of Evidence:

Keywords

Get full access to this article

References

Supplementary Material