The combined talus and sustentaculum fracture: A case series.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest No author received any direct funding from any agencies in the public, commercial, or not-for-profit sectors specifically for this work. DLR receives reimbursement as an educator for AO Trauma North America and has stock ownership in Purgo Scientific. TFH receives grant funding through the U.S. Department of Defense, consulting fees from DePuy Synthes and Globus, has stock ownership in Orthogrid, SMV Holdings, NT nPhase, Imagen, and has leadership roles on the Orthopedic Trauma Association Board of Directors. JMH receives grant funding through the Arthritis Foundation, consulting fees from Stryker, Orthogrid, Osteocentric, Newclip Technics, is a participant on NIAMS Safety Officer for PA-20-206 advisory board, and has leadership roles for Orthopedic Trauma Association, Western Orthopedic Association, and AO Foundation. For the remaining authors, none were declared. 12. J Orthop Trauma. 2024 Jun 1;38(6):220-224. doi: 10.1097/BOT.0000000000002798. Talar Neck Fractures With Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis. Srinath A(1), Southall WGS(2), Nazal MR(2), Mechas CA(2), Foster JA(3), Griffin JT(3), Muhammad M(3), Moghadamian ES(2), Landy DC(4), Aneja A(3). Author information: (1)Department of Orthopaedic Surgery, University of Miami, Miami, FL. (2)Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY. (3)Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; and. (4)OrthoVirginia, Lynchburg, VA. OBJECTIVES: To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared with isolated talar neck fractures (ITNs). DESIGN: Retrospective cohort. SETTING: Single level I trauma center. PATIENT SELECTION CRITERIA: Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least 6-month follow-up. Based on radiographs at the time of injury, fractures were classified as ITN or TNIFAF and by Hawkins classification. OUTCOME MEASURES AND COMPARISONS: The primary outcome was the development of AVN based on follow-up radiographs, with secondary outcomes including nonunion and collapse. RESULTS: There were 115 patients who sustained talar neck fractures, with 63 (55%) in the ITN group and 52 (45%) in the TNIFAF group. In total, 63 patients (54.7%) were female with the mean age of 39 years (range, 17-85), and 111 fractures (96.5%) occurred secondary to high-energy mechanisms of injury. There were no significant differences in demographic or clinical characteristics between groups ( P > 0.05). Twenty-four patients (46%) developed AVN in the TNIFAF group compared with 19 patients (30%) in the ITN group ( P = 0.078). After adjusting for Hawkins classification and other variables, the odds of developing AVN was higher in the TNIFAF group compared with the ITN group [odds ratio, 2.43 (95% confidence interval, 1.01-5.84); ( P = 0.047)]. CONCLUSIONS: This study found a significantly higher likelihood of AVN in patients with talar neck fractures with concomitant ipsilateral foot and/or ankle fractures compared to those with isolated talar neck fractures after adjusting for Hawkins classification and other potential prognostic confounders. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BOT.0000000000002798