A comparative study of three different approaches in treatment of talar neck fractures

Abstract

Purpose: The primary objective of this study was to observe and compare the radiographic and clinical outcomes among three different approaches which are anteromedial, anterolateral and combined approach in patients of talar neck fractures. The secondary objective was to observe various complications.

Material and method: A total of 30 patients underwent open reduction and internal fixation (ORIF) from September 2018 to march 2020 were selected retrospectively. 10 patients were there in each group. Talar neck fractures were classified according to Hawkins classification. All patients underwent ORIF with 4 mm Herbert screws. The follow-up examination included radiological evaluation, clinical and functional outcomes according to American Orthopaedic Foot and Ankle Society hind-foot score (AOFAS).

Results: 30 patients were followed up for an average of 20.85 months (range 16-24). The mean time to bony union was 17.25 weeks, 17.35 weeks and 15.92 weeks in groups operated with anteromedial approach, anterolateral approach and combined approach respectively. The mean AOFAS hind-foot score was 76.34, 77.16 and 78.34 at 18th month follow-up in all three groups respectively. In each group, 1 patient had deep wound infection and 2 patients had superficial wound infection. Subtalar arthritis was the most common complication.

Conclusion: There is no significant difference between the three groups in terms of AOFAS hind-foot score, further combined approach provides better visualization of talus fractures and early bony union but it takes longer duration of surgery with increased post-operative complications in comparison with other two groups.

Keywords: AOFAS hind-Foot score; Hawkins classification; Sneppen classification; Talus fractures.

Fig. 1

A bar graph showing Interval between injury and surgery (days) and duration (minutes) among different groups.

Fig. 2

A bar graph showing AOFAS hind-foot score in successive follow-up among different groups.

Fig. 3

a) Preoperative AP and lateral radiograph of talus neck fracture (Hawkins type 2) with medial malleolus fracture, b) Post-operative AP and lateral radiograph of talus neck with two 4 mm Herbert screw fixation from posterior to anterior direction with k-wire TBW of medial malleolus.

Fig. 4

a) Postoperative radiographs at 6th month follow-up showing united talus and medial malleolus fracture. b) Postoperative radiograph at 12th month follow-up showing changes of osteonecrosis of talus and subtalar arthritis, c) Postoperative radiograph at 18th month follow-up showing marked changes of subtalar arthritis and osteonecrosis.