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Talar Neck Fractures

  • D’Hooghe PieterEmail author
  • Bukva Bojan
  • Krivokapic Branislav
Chapter

Abstract

Fractures of the talar neck are rare but serious injuries. They are frequently seen in high-energy and polytraumatized patients and can evolve to debilitating complications and functional limitations. The vast majority of talar fractures are intra-articular fractures.

When adjacent soft tissue injury permits, urgent reduction of associated dislocation is mandatory, together with open reduction and internal fixation (ORIF) for displaced fractures. Restoration of articular and axial alignment in the surgical treatment setup is necessary to optimize ankle function.

To obtain a complete intraoperative overview allowing for anatomical reconstruction of the articular surfaces and the axial alignment, bilateral surgical approaches are usually necessary. Internal fixation is achieved with screws or mini-plates supplemented by temporary K-wires fixation. Preoperative planning requires a computed tomography (CT) scan.

The clinical outcome after talar neck fractures is determined by the injury severity and the quality of initial reduction and internal fixation. The timing of definite internal fixation does not appear to affect the final result.

The rate of avascular necrosis (AVN) correlates with the initial degree of dislocation. Only total AVN with collapse of the talar body leads to poor results with the potential need additional surgery. Prolonged immobilization or off-loading of the affected foot is contraindicated for partial AVN. Talar neck malunions and nonunions are conditions that require surgical correction, and they often require additional autograft bone interposition. Other treatment options include corrective osteotomy, treatment of pseudarthrosis with secondary fixation, free or vascularized bone grafting, and in many cases fusion procedures of the affected joint(s).

The most common long-term complication after talar neck fracture is posttraumatic arthritis (PTA). The rate of PTA appears to increase over time.

Ideally—and with careful attention to surgical timing and technique—complications can be limited to the characteristics of the initial injury, including direct soft tissue damage, blood supply insufficiency, and articular cartilage and bony damage.

An arthroscopic-assisted ORIF technique can offer advantages in the treatment of talar neck fractures, such as improved ankle and subtalar joint anatomical congruency restoration.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • D’Hooghe Pieter
    • 1
    Email author
  • Bukva Bojan
    • 2
  • Krivokapic Branislav
    • 3
  1. 1.Department of Orthopaedic SurgeryAspetar Orthopaedic and Sportsmedical HospitalDohaQatar
  2. 2.Aspetar Orthopaedic and Sports Medical HospitalDohaQatar
  3. 3.Institute for Orthopaedic Surgery and Traumatology “Banjica”BelgradeSerbia

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