TREATMENT RESULTS IN TALUS FRACTURES

Abstract

Introduction: Talus fractures are rare, but because of its peculiar anatomy the complications rate is high. Its arterial vascularisation can be compromised by trauma in displaced fractures or by the surgical approaches.

Material and methods: Between 2001 and 2005, 30 patients with talus fractures were surgically treated in the Department of Orthopedics and Traumatology of Bucharest University Hospital. Sex ratio was 3 men/27 men. 27 fractures were closed. The mean age was 37 years (extremes: 17 – 54 years). Fractures were classified according to Hawkins classification: type I – 9 cases, type II – 13 cases, type III – 8 cases. All patients underwent clinical and radiological examinations at 3, 6 and 12 months and every year after this interval.

Results: Hawkins type I fractures were treated by cast immobilization without weight bearing for 6 to 8 weeks. Orthopedic reduction was performed in emergency in order to avoid vascular and cutaneous complications. Hawkins type II and III fractures were surgically treated. Anterior or transmaleolar internal surgical approaches were used. After reduction, osteosynthesis with 2 or 3 compression screws was performed. Avascular necrosis of talus was observed in 6 cases (5 type III fractures, 1 type II case). Cutaneous complications were observed more frequently in type II and III fractures and in the neglected ones. Sepsis occurred in one case. 80% of cases with avascular necrosis developed osteoarthritic changes. Radiological union was observed in average at 6 months.

Conclusions: The prognosis of fracture-dislocation of talus is reserved, because of the high rate of avascular necrosis and osteoarthritis. The most important factors associated with good results are short time interval between trauma and surgical treatment and a perfect reduction. The surgical approach must avoid extensive devascularization of talus neck. Prolonged cast immobilization and long time avoidance of weight bearing favourably influenced fracture union. The most important complication is avascular necrosis.