Authors : Shanmuganathan Rajasekaran, Arunkamal Chandramohan, Dheenadhayalan Jayaramaraju, Ramesh Perumal, Ranjit K Patra, Velmurugesan P Sundaram
DOI : 10.5005/jp-journals-10040-1339
Volume : 11
Issue : 3
Year : 2024
Page No : 111-116
Background: Talus fractures comprise approximately 0.1–0.85% of all fractures. They usually present following a high-velocity trauma and with soft tissue damage. Our objectives are to study whether the fracture morphology, the timing of intervention, the injury status, and the presence of Hawkin's sign influence the outcomes in operated cases with talus fractures. To test our hypothesis that open talus fractures, talus body fractures with comminution, and the time delay in initiating treatment cause poor results. Materials and methods: It is a retrospective analysis of all operated talus fractures between 2015 and 2019. Of the total 62 patients, 49 patients met our inclusion criteria. Preoperative X-rays and preoperative computed tomography (CT) scans were analyzed. Based on the fracture morphology, cases were divided into groups A (talus neck) and B (talus body). Postoperative assessment for the fracture union, presence of Hawkin's sign, the incidence of avascular necrosis (AVN), rate of infections, and secondary arthritis were noted. The functional outcomes were calculated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Among 49 patients, 34 talus neck fractures and 15 talus body fractures were assessed. The risk of AVN in talus neck fracture increases with injury severity (p-value of 0.04). There was no statistical difference between the closed and open talus fractures regarding AVN, infection rate, and secondary arthritis. The mean AOFAS score was 84.9 in group I and 81.8 in group II. Hawkin's sign showed 61.1% reliability for detecting AVN. However, the specificity is limited. Conclusion: The talus neck and body fracture outcome did not vary significantly. The incidence of AVN positively correlated with the increasing severity of the talus neck fracture. According to Sneppen's fracture variants, the sagittal split-type talus body fracture had a marginally better outcome than the coronal split type and crushing-type body fracture with comminution. The rates of infection and AVN between closed and open talus fractures and the initial time delay for surgery did not influence our final results, and there was no statistical difference.