Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2012; 79(2):119-123 | DOI: 10.55095/achot2012/017

Chirurgické léčení zlomenin krčku a těla taluPůvodní práce

J. ZEMAN^*, J. MATĚJKA, T. PAVELKA

Klinika ortopedie a traumatologie pohybového ústrojí LF UK a FN Plzeň

PURPOSE OF THE STUDY:
To present a retrospective evaluation of the results of our method of open reduction and internal fixation.

MATERIAL AND METHODS:
A total of 35 patients were surgically treated for talar fractures at our department between 2004 and 2008. There were 27 men and eight women, with an average age of 31 years (range, 21 to 65). Talar neck fractures were recorded in 21 and talar body fractures in 14 patients.
The most frequent cause of injury was a fall from height (77%); motorcar accidents were less frequent (14%). Open fractures were found in 8.5% of the patients, and talar fractures as a single trauma were recorded in 80% of them. Indication criteria for surgery included displaced talar neck (Hawkins type II to type IV) and body fractures, with a displacement exceeding 1 mm. The traction screw osteosynthesis used was combined with plate fixation in some patients. Full weight-bearing of the extremity was allowed from 12 post-operative months. The patients were followed up at 6 weeks, 3, 6 and 12 months and then at yearly intervals. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate the results.

RESULTS:
Of the 35 fractures, 16 (45.7%) were treated surgically on the day of injury and 19 (54.3%) on subsequent days. The injury-surgery interval ranged from 0 to 12 days (average, 8 days). Primary bone union was recorded in 34 patients (97%) within 16 weeks of surgery; pseudoarthrosis developed in one patient. The results were excellent in eight (23%), good in 11 (31%) and satisfactory in seven (20%) patients. Poor outcome including function was reported by nine (26%) patients. The poor results were mostly due to associated tibial pilon fractures or because of arthrodesis necessary to be performed for management of necrosis or arthritis.
Complications were recorded in 22 patients (63%) and included avascular necrosis in six (17%), traumatic arthritis of the tibiotalar and subtalar joints in 14 (40%) patients and pseudoarthrosis in one (3%) patient. This was treated by corticocancellous graft implantation and repeated osteosynthesis, and bone union occurred within 6 months. Traumatic arthritis was managed by arthrodesis in seven patients.

DISCUSSION:
Dislocated talar neck and body fractures are always indicated for surgery. The surgical procedure used depends on the patient's injury, surgeon's experience and skills, surgical department's system and fracture type. The timing of surgery is related to the type of injury and soft tissue disturbance. The primary demand is to reduce the fracture as soon as possible; a definite treatment may be postponed. Open fractures require urgent management. The treatment should be completed by an experienced surgeon after subsidence of soft tissue oedema when there is no longer the risk of compartment syndrome development. Injury brings about blood flow disturbance, with its extent relative to the type of injury, which may result in avascular necrosis. However, the timing of surgical treatment plays no role in the development of complications such as avascular necrosis or traumatic arthritis.

CONCLUSIONS:
Surgical management of dislocated talar neck and body fractures by open reduction and osteosynthesis does not achieve very good results. The definitive treatment should be carried out by an experienced surgeon and at a department with routine performance of these procedures. The results show that a delayed treatment by open reduction and stable osteosynthesis has better long-term outcomes than a rash acute operation done by an incomplete or less experienced operating team.

Klíčová slova: fractures of the neck and body of the talus, surgical treatment

Zveřejněno: 1. duben 2012  Zobrazit citaci