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. 7. Acta Chir Orthop Traumatol Cech. 2017;84(2):120-124. [Talar Neck Fractures Treated Using Percutaneous Screw Fixation]. [Article in Czech] Veselý R(1), Kelbl M, Kacián J, Hulka V, Kočiš J, Kunovský R. Author information: (1)Úrazová nemocnice v Brně, Klinika traumatologie Lékařské fakulty Masarykovy univerzity Brno. PURPOSE OF THE STUDY Closed reduction and percutaneous fixation of nondisplaced talar neck fractures have been applied by some authors. The aim of this paper is to assess the results and complications of this minimally invasive technique. MATERIAL AND METHODS In the period from 2009 to 2014, twenty-one patients with a talar neck fracture were observed after closed reduction and percutaneous screw fixation in the Traumatological Hospital in Brno. The mean age of the patients was 38 years (range 18-56 years). The mechanism of injury was a motor vehicle accident in 11 cases, a fall from height in six cases, a sports injury in 3 cases, and a fall from stairs in one case. Injuries were classified according to the Hawkins classification. Conventional preoperative 3-dimensional CT scans of the fractures were analysed. Under the guidance of C-arm fluoroscopy, Kirscher wires were used for closed reduction and temporary percutaneous fixation. Subsequently, 3.5 and 4.5 mm diameter cannulated screws were inserted. The outcome was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. RESULTS The average follow-up was 32 months (21-42 months). The average healing time was 15.5 weeks (13-19 weeks). The average AOFAS score was 82.3 points (69-96 points). 75% of patients with type I injury achieved excellent results and 72% of patients with type II injury achieved excellent or good results. None of the patients developed wound complications. Two patients developed partial avascular necrosis and three patients subtalar traumatic arthritis after surgery. DISCUSSION Talar neck fractures are relatively uncommon fractures. Most of the published studies are small. Tenuous blood supply and displaced talar neck fracture predispose to avascular necrosis of the talus. Closed reduction and percutaneous fixation can reduce the soft tissue damage and disturbance to the blood supply. CONCLUSIONS Preoperative 3D CT scans, early surgery, anatomic articular surface reduction and percutaneous screw fixation increase the fracture healing rate and reduce the incidence of talar avascular necrosis. Key word: talus, closed reduction, percutaneous fixation, screw.