Talar neck fractures are rare injuries representing only 0.14%–0.32% of all fractures, one in five of these is open. In order to investigate the hypothesis that open talar neck fractures have worse outcome than closed ones, we did a Metaanalysis of the literature. Manuscripts dealing with fractures of the talus were identified from a Pubmed search including databases from 1970 to 2004. The searches were made using the keywords talar fractures, fractures of the neck of talus, outcome of talar fractures and open talar fractures. Full articles were retrieved and methodological quality filters applied for their suitability for inclusion in a more detailed review. Data were extracted from these articles and methodology and outcome were analyzed.

We analyzed the numbers of patients, numbers of open fractures, mechanism of injury, associated injuries, classification used, treatment methods, complications and outcome. Of 29 manuscripts reviewed, 22 met the inclusion criteria. These were subjected to more detailed analysis, the outcomes of 1017 patients were described. The commonest mechanism of injury was road traffic accidents (42%). The incidence of Hawkins’ types was type I 27%, type II 35%, type III 30% and type IV 8%. More than half the patients were treated by open reduction and internal fixation. Medial malleolar fracture was the most common associated injury. The overall incidence of avuscular necrosis was 30%. 23% developed ankle osteoarthritis, 34% subtalar and 7.5% both. 17 % of all patients have had one form of arthrodesis. 22% were open injuries and only few authors reported the detailed treatment and outcome of their open fractures, however infection rate was higher in open injuries and they tend to be associated more with type III and IV Hawkins’ classification. The fate of the extruded talus remains controversial. In conclusion, it appears that the current literature is poor in providing evidence based medicine in the management and outcome of open talar neck fractures. More detailed studies should be done to shed more light on the fate of these rare and disabling injuries.

Purpose: This study was carried out in order to assess the results of reconstruction of a deficient extensor mechanism in the presence of total knee replacement using Connective Tissue Prosthesis (CTP).

Methods & results: The CTPs are available as flat tapes constructed from polyester in an open weave structure. They were used to reinforce and reconstruct the extensor mechanism which was deficient in three patients who had undergone total knee replacement or were about to undergo total knee replacement. Two cases had extensor mechanism deficiency as a complication following total knee replacement while the third case had extensor mechanism deficiency at the time of the primary knee reconstruction. The average follow-up was one year. All three cases showed good results with no extension lag and good range of movement at follow up.

Conclusion: A Connective Tissue Prosthesis Reconstruction of the knee extensor mechanism offers a good option for the management of the uncommon but difficult problem of extensor mechanism deficiency in patients with a total knee arthroplasty.