DISPLACED TALAR NECK FRACTURES TREATED WITH INTERNAL FIXATION USING LAG SCREWS

Abstract

The aim of this study was to evaluate the early results and complications of internal fixation for displaced fractures of the talar neck.

A retrospective review was undertaken of displaced talar neck fractures. 35 patients had open reduction and lag screw fixation during a 16-year period. All patients were followed with serial radiographs for at least three years.

There were 25 males and 10 females with a mean age of 31 years (range 15–61 years). The most common mechanism of injury was fall from height (n=13) and motor vehicle accidents (n=l1). There was one bilateral fracture. Ipsilateral ankle fractures occurred in 5 patients (14%) and 8 patients (23%) had multiple injuries. There were 31 Hawkins’ type II fractures and 5 Hawkins’ type III fractures. 25 patients (71%) had no complications as a result of their injuries or surgery. All fractures united within 6 months. There was one deep infection (3%) in a IIIB open fracture that required early amputation. 8 patients developed avascular necrosis: 6 Hawkins’ type II fractures (19%) and 2 Hawkins’ type III fractures (40%). Avascular necrosis was more common if surgery was delayed beyond 24 hours but this may reflect the severity of injury rather than the timing of surgery. The outcome following avascular necrosis was poor in general and 5 patients (63%) required hindfoot fusion.

Talar neck fractures are rare. This is the first study from the UK to evaluate this injury and it is the first to look specifically at one method of operative treatment. In general, the early results were good with only 1 deep infection (3%) and all fractures united following lag screw fixation. Avascular necrosis remains the most common complication but, compared with other studies, we report low rates of this problem.

Good results can be obtained following lag screw fixation of displaced talar neck fractures. The complication rate is low but avascular necrosis remains a serious problem.