Abstract
Research Type:
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose:
Talar neck fractures are rare injuries but clinically significant due to the talus’s unique vascular supply which makes it highly susceptible to avascular necrosis (AVN). Social determinants of health (SDOH), encompassing socioeconomic status, housing, and education, are increasingly recognized as critical factors influencing outcomes in orthopedic care. This study aims to investigate the impact of SDOH on the development of AVN and other complications including surgical site infections (SSI), venous thromboembolism (VTE), and non-union after talar neck fractures requiring surgical intervention.
Methods:
A retrospective analysis was conducted on 168 patients who sustained talar neck fractures and underwent surgical treatment between 2018 and 2023. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) ADI and SVI values were collected based on patients' residential areas. The occurrence of complications such as AVN, SSI, VTE, and non-union was recorded. Independent T-tests were performed to assess differences between patient groups, with a significance threshold of p< 0.05.
Results:
A total of 9.3% of patients developed AVN, with no significant differences in ADI or SVI scores between those with and without AVN (p>0.05). Additionally, no significant associations were found between ADI/SVI values and the occurrence of SSI, VTE, or non-union. The number of surgeries was significantly higher in the AVN group (p < 0.001), suggesting that secondary surgical interventions were related to AVN. Hawkins fracture classification showed a strong correlation with AVN, particularly for types III and IV fractures (p < 0.001), reinforcing the prognostic value of the classification system.
Conclusion:
While AVN is significantly associated with more severe Hawkins fracture types and often results in multiple additional surgical interventions, no significant correlation was found between SDOH factors and the development of AVN, SSI, or other complications. These findings suggested that injury severity, rather than socioeconomic factors, plays a more critical role in AVN risk. Further research is warranted to explore how individual-level social factors may influence complication rates or whether higher fracture severity types may predominate in specific subpopulations of patients.