Novosti
Khirurgii
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Year 2019 Vol. 27 No 3

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DOI: https://dx.doi.org/10.18484/2305-0047.2019.3.337   |  

A. SITNIK

TREATMENT OF THE FRACTURES OF THE NECK OF THE TALUS

Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk,
The Republic of Belarus

Fractures of the talus are rare injuries (up to 2.5% from the foot fractures), but the consequences of incorrect treatment are catastrophic, leading to osteoarthritis and long-lasting function impairment. Fearing complication is avascular necrosis of the body of the talus with previously reported incidence up to 50-75%. The changes of surgical strategy during the last decades have led to significant improvement of results and decrease of complications. Urgent treatment is only indicated in open injuries, as well in cases of fracture-dislocations where the displaced bone fragment threatens with skin necrosis. If closed reduction is successful, internal fixation is better to perform in delayed manner after the resolution of soft-tissue swelling. According to the present-day literature data, such an approach does not lead to the increase of the rate of avascular necrosis, but reduces the rate of wound complications and improves long-term results by thorough pre-operative planning and execution of surgery. The use of double surgical approaches (antero-medial and antero-lateral) provides anatomic fracture reduction with maintenance of the tiny blood supply of talus bone.

Keywords: talus, fracture, treatment terms, osteosynthesis, complications
p. 337-343 of the original issue
References
  1. Rammelt S, Zwipp H. Talar neck and body fractures. Injury. 2009 Feb;40(2):120-35. doi: 10.1016/j.injury.2008.01.021
  2. Vallier HA. Fractures of the talus: state of the art. J Orthop Trauma. 2015 Sep;29(9):385-92. doi: 10.1097/BOT.0000000000000378
  3. Grear BJ. Review of talus fractures and surgical timing. Orthop Clin North Am. 2016 Jul;47(3):625-37. doi: 10.1016/j.ocl.2016.03.008
  4. Mulfinger GL, Trueta J. The blood supply of the talus. J Bone Joint Surg Br. 1970;52:160-67. https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620x.52b1.160
  5. Kuner EH, Lindenmaier HL, Münst P. Talus fractures. In: Schatzker J, Tscherne H, editors. Major fractures of the pilon, the talus and the calcaneus. Springer-Verlag Berlin Heidelberg; 1993. p. 71-85. doi: 10.1007/978-3-642-77729-5
  6. Cronier P, Talha A, Massin P. Central talar fractures therapeutic considerations. Injury. 2004 Sep;35 (Suppl 2):SB10-22. doi: 10.1016/j.injury.2004.07.009
  7. Peterson L, Goldie IF, Irstam L. Fracture of the neck of the talus. A clinical study. Acta Orthop Scand. 1977;48(6):696-706. doi: 10.3109/17453677708994820
  8. Fracture and Dislocation Classification Compendium 2018. Foot. J Orthop Trauma. 2018 Jan;32(1 Suppl):S89-S100. doi: 10.1097/BOT.0000000000001060
  9. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970 Jul;52(5):991-1002. https://journals.lww.com/jbjsjournal/Abstract/1970/52050/Fractures_of_the_Neck_of_the_Talus.13.aspx
  10. Ishikawa SN. Fractures and dislocations of the foot. In: Canale ST, Beaty JH, editors. Campbells operative orthopaedics. 12th ed. Philadelphia: Elsevier; 2013.
  11. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978 Mar;60(2):143-56. https://journals.lww.com/jbjsjournal/Abstract/1978/60020/Fractures_of_the_neck_of_the_talus__Long_term.1.aspx
  12. Whitaker C, Turvey B, Illical EM. Current Concepts in Talar Neck Fracture Management. Curr Rev Musculoskelet Med. 2018 Sep;11(3):456-74. doi: 10.1007/s12178-018-9509-9
  13. Buza JA 3rd, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg. 2018 Aug;24(4):282-90. doi: 10.1016/j.fas.2017.04.008
  14. Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, Falaise V, Pineau V, Salle de Chou E, Noailles T, Carvalhana G, Ruhlmann F, Huten D. Total talar fracture long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res. 2012 Jun;98(4 Suppl):S48-55. doi: 10.1016/j.otsr.2012.04.012
  15. Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am. 2004 Aug;86-A(8):1616-24. https://brightonorthoeducation.files.wordpress.com/2012/09/talar-neck-fractures-jbjs-am-2004-p1616.pdf
  16. Grob D, Simpson LA, Weber BG, Bray T. Operative treatment of displaced talus fractures. Clin Orthop Relat Res. 1985 Oct;(199):88-96. doi: 10.1097/00003086-198510000-00013
  17. Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014 Feb 5;96(3):192-97. doi: 10.2106/JBJS.L.01680
  18. Xue Y, Zhang H, Pei F, Tu C, Song Y, Fang Y, Liu L. Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. Int Orthop. 2014 Jan;38(1):149-54. Published online 2013 Dec 3. doi: 10.1007/s00264-013-2164-2
  19. Lindvall E, Haidukewych G, DiPasquale T, Herscovici D Jr, Sanders R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004 Oct;86(10):2229-34. doi: 10.2106/00004623-200410000-00014
  20. Babu N, Schuberth JM. Partial avascular necrosis after talar neck fracture. Foot Ankle Int. 2010 Sep;31(9):777-80. doi: 10.3113/FAI.2010.0777
  21. Gerken N, Yalamanchili R, Yalamanchili S, Penagaluru P, Md EM, Cox G. Talar revascularization after a complete talar extrusion. J Orthop Trauma. 2011 Nov;25(11):e107-10. doi: 10.1097/BOT.0b013e318210f236
  22. Sanders DW, Busam M, Hattwick E, Edwards JR, McAndrew MP, Johnson KD. Functional outcomes following displaced talar neck fractures. J Orthop Trauma. 2004 May-Jun;18(5):265-70. doi: 10.1097/00005131-200405000-00001
Address for correspondence:
220024, The Republic of Belarus,
Minsk, Kizhevatov Str., 60-4,
Republican Scientific and Practical
Center of Traumatology and Orthopedics,
Laboratory of Adult Traumatology,
Tel. mobile: +375 29 354-00-84,
e-mail: alexandre_sitnik@yahoo.com,
Alexandre A. Sitnik
Information about the authors:
Sitnik Alexandre A., PhD, Associate Professor, Head of the Laboratory of Adult Traumatology, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus.
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