[What are the clinical results of operated fractures of the talus?]. / Wie sind die klinischen Ergebnisse operativ behandelter Talusfrakturen?

ABSTRACT

UNLABELLED Our study focuses to determine the medium range results of function and radiological findings of operatively treated fractures of the talus. Furthermore we had the intention to investigate risk-factors for posttraumatic arthrosis and necrosis of the talus. MATERIAL AND METHODS: We included all 41 patients (w/m 13/28) operated between 1995-2000 with talus neck, corpus or dislocated fracture of the talus edge (open/closed 11/30). Fractures were classified according to Hawkins type 1 6 x, type II 17 x, type III 7 x, type IV 3 x, 8 x dislocated peripheral fractures. 39 x screw osteosynthesis, 2 x K-wire fixation were done and 12 additive transfixation with fixateur externe. Score AOFAS Ankle-Hindfoot-Scale, radiological assessment according to the Bargon score. 34 patients, mean age 35 years (12-60), were followed up clinically with an average of 4 years (24-72 months). RESULTS: AOFAS Score pain (40 points) diameter 31 [10-40]; function (50 points) diameter 39 [14-50]; alignement (10 points)diameter 7 [0-10]; degree of arthritis due to the Bargon scale 0 degree 5x,1 degree 8x, 2 degrees 7 x, 3 degrees 7 x. COMPLICATIONS 4 x necrosis of margin of the wound, 1 deep infection, 5 necrosis of the talus bone. The severity of the fracture was 1 x type II according to Hawkins 3 x type III and 1 x type IV. 3 of the 5 patients who developed a talus necrosis had 28 or 38 soft tissue damage. One patient had an imminent compartment syndrome. One patient who suffered a polytrauma was operated six days post injury. Second operation 1 Syme amputation due to necrosis of the talus subsequent to an infection. 4 x arthrodesis of the upper ankle joint and 5 x arthrodesis of the subtalar joint due to posttraumatic arthritis. CONCLUSION: Primary screw osteosynthesis is the treatment of choice depending on the lesions of the soft-tissue and accompanied injuries in combination with a fixateur externe. Nevertheless the primary osteosynthesis is not able to prevent necrosis of the talus completely, that occurs in a frequency of 15%. Risk factors for a posttraumatic arthritis in addition to the type of fracture and the result of reconstruction are an accompanied soft tissue defect and local capsule-band complex with necessary temporary transfixation. Early plastic reconstruction of defects can reduce the time of immobilisation and allows motion therapy. The functional results are positive compared with the radiological results that showed arthritis in 70%.