Partial avascular necrosis after talar neck fracture.

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Abstract

[Indexed for MEDLINE] 15. Injury. 2021 Jul;52 Suppl 3:S89-S96. doi: 10.1016/j.injury.2021.01.047. Epub 2021 Jun 1. Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation-systematic review and meta-analysis. Giordano V(1), Liberal BR(2), Rivas D(2), Souto DB(2), Yazeji H(2), Souza FS(2), Godoy-Santos A(3), Amaral NP(2). Author information: (1)Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil; Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil. Electronic address: v_giordano@me.com. (2)Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil. (3)Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil. PURPOSE: To provide a direct comparison between two important aspects related to talar neck fractures management - surgical approaches and fixation strategies. DATA SOURCES: A systematic review and meta-analysis was performed using PubMed, SciELO, and gray literature databases. The keyword "talus fracture" and the combined terms "talus neck fracture AND surgical approach" and "talus neck fracture AND fixation strategy" were used. STUDY SELECTION: Study selection, data extraction, and the risk of bias assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were limited to human studies and the English and Portuguese. Inclusion criteria were articles in full text that reported on any aspect of surgical approach and fixation strategy for talus neck fractures. Exclusion criteria were skeletally immature patients, mean follow-up of less than 12 months, studies that did not use the Hawkins classification system, primary treatment of arthrodesis, studies published before year 2000, and studies published in languages other than English and Portuguese. DATA EXTRACTION: Basic information was collected including journal, author(s), year published, level of evidence, number of fractures, and follow-up. Specific information was collected including fracture classification, surgical approach, fixation strategy, complication rate, type of complication(s), and outcome measurement(s). DATA SYNTHESIS: Fixed-effects model was used for meta-analysis. The choice for surgical approach(es) and fixation strategy was stratified based on fracture classification. Complication rate, type of complication(s), and outcome measurement(s) were calculated for all studies and delineated by fracture classification. CONCLUSION: There is a significant correlation between poor scores and poor fracture reduction, but not with the modified Hawkins classification, surgical approach, and fixation strategy. The presence of an open talus neck fracture-dislocation jeopardizes the functional outcome, increasing the risk of complications. The overall avascular necrosis and post-traumatic osteoarthritis event rate was 0.279 and 0.400, respectively. Both complications were highly correlated to higher energy fracture patterns and to the use of combined approaches, but not to fixation strategy. LEVEL OF EVIDENCE: I (systematic review and meta-analysis). Copyright © 2021 Elsevier Ltd. All rights reserved. DOI: 10.1016/j.injury.2021.01.047