Fracture neck of the talus with isolated talonavicular dislocation: A case report.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors have no conflicts of interest to disclose. 16. 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