Long-term Functional Outcomes After Modern Surgical Treatment of Talus Fractures: A 10-Year Single Center Cohort Study

Abstract

Background:

Talus fractures are rare injuries. To date, there is limited literature on outcomes after modern operative treatment of talus fractures. Many prior studies are limited by a small number of patients, limited follow-up, and include radiographic outcomes only. The purpose of this study was to report long-term patient-reported outcomes after operative treatment of talus fractures.

Methods:

This was a retrospective cohort study of patients with a talus fracture treated surgically at a level 1 trauma center between 2008 and 2018, with a minimum of 5 years of follow-up.

Detailed demographic, injury, and radiographic data were collected. Attempts were made to contact all patients for long-term follow-up to collect the Foot and Ankle Ability Measure (FAAM) patient-reported outcome score.

Results:

One hundred twenty-eight patients met inclusion criteria and were successfully contacted for follow-up. The average length of follow-up was 10.4 years. There was a 47% rate of posttraumatic arthritis. Thirty-eight patients (30%) underwent unplanned reoperation, of which 12 (9%) were a salvage procedure (fusion, arthroplasty, or amputation). Median FAAM score at a mean of 10 years was 83 (interquartile range [IQR] 58-96). For patients who did not require a salvage procedure (fusion, arthroplasty, or amputation), the median FAAM score was 85 (IQR 63-96). In contrast, those who underwent a salvage procedure had a median FAAM score of 52 (IQR 36-65), representing significantly poorer function. In univariate analysis, factors associated with lower FAAM score included open injuries, higher Injury Severity Score (ISS), and elevated body mass index (BMI). Additional negative predictors included increased time to definitive surgery, presence of a subtalar dislocation, development of subtalar arthritis, undergoing any reoperation, and salvage procedures. Fracture location, Hawkins classification, development of avascular necrosis, age, reoperations excluding salvage procedures, presence of ipsilateral foot/ankle fractures, and duration of follow-up were not independently associated with FAAM score. In multivariate analysis, only undergoing a salvage procedure and increasing BMI and ISS remained associated with poorer FAAM scores.

Conclusion:

In a large cohort of surgically treated talus fractures, long-term functional outcomes were better than anticipated, with a median FAAM score of 83 despite a 47% rate of posttraumatic arthritis and 30% reoperation rate. These results suggest that modern dual-approach surgical techniques may substantially improve patient prognosis compared with historical expectations.