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. 2024 Jun 1;38(6):220-224.
doi: 10.1097/BOT.0000000000002798.

Talar Neck Fractures With Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis

Arjun Srinath  1 , Wyatt G S Southall  2 , Mark R Nazal  2 , Charles A Mechas  2 , Jeffrey A Foster  3 , Jarod T Griffin  3 , Maaz Muhammad  3 , Eric S Moghadamian  2 , David C Landy  4 , Arun Aneja  3
Affiliations

Talar Neck Fractures With Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis

Arjun Srinath et al. J Orthop Trauma. .

Abstract

Objectives: To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared with isolated talar neck fractures (ITNs).

Design: Retrospective cohort.

Setting: Single level I trauma center.

Patient selection criteria: Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least 6-month follow-up. Based on radiographs at the time of injury, fractures were classified as ITN or TNIFAF and by Hawkins classification.

Outcome measures and comparisons: The primary outcome was the development of AVN based on follow-up radiographs, with secondary outcomes including nonunion and collapse.

Results: There were 115 patients who sustained talar neck fractures, with 63 (55%) in the ITN group and 52 (45%) in the TNIFAF group. In total, 63 patients (54.7%) were female with the mean age of 39 years (range, 17-85), and 111 fractures (96.5%) occurred secondary to high-energy mechanisms of injury. There were no significant differences in demographic or clinical characteristics between groups ( P > 0.05). Twenty-four patients (46%) developed AVN in the TNIFAF group compared with 19 patients (30%) in the ITN group ( P = 0.078). After adjusting for Hawkins classification and other variables, the odds of developing AVN was higher in the TNIFAF group compared with the ITN group [odds ratio, 2.43 (95% confidence interval, 1.01-5.84); ( P = 0.047)].

Conclusions: This study found a significantly higher likelihood of AVN in patients with talar neck fractures with concomitant ipsilateral foot and/or ankle fractures compared to those with isolated talar neck fractures after adjusting for Hawkins classification and other potential prognostic confounders.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

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