This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activity for this article:
 Foot and Ankle Test 1: Trauma about the Foot and Ankle
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Related articles in JBJS
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Vallier, H. A.
Right arrow Articles by Sangeorzan, B. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vallier, H. A.
Right arrow Articles by Sangeorzan, B. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery (American) 85:1716-1724 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Surgical Treatment of Talar Body Fractures

Heather A. Vallier, MD, Sean E. Nork, MD, Stephen K. Benirschke, MD and Bruce J. Sangeorzan, MD

Investigation performed at the Harborview Medical Center, Seattle, Washington

Heather A. Vallier, MD
Department of Orthopaedic Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. E-mail address: heathervallier{at}yahoo.com
Sean E. Nork, MD
Stephen K. Benirschke, MD
Bruce J. Sangeorzan, MD
Department of Orthopaedic Surgery, Harborview Medical Center, Box 359798, 325 Ninth Avenue, Seattle, WA 98104-2499

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Fractures of the body of the talus are uncommon and poorly described. The purposes of the present study were to characterize these fractures, to describe one treatment approach, and to evaluate the clinical, radiographic, and functional outcomes of operative treatment.

Methods: Fifty-six patients with fifty-seven talar body fractures who had been treated operatively during a sixty-seven-month period at a level-1 trauma center were identified with use of a database. Twenty-three patients had a concomitant talar neck fracture. Eleven of the fifty-seven fractures were open. All patients underwent open reduction and internal fixation. Complications, secondary procedures, and the ability to return to work were evaluated at a minimum of one year. The radiographic presence of osteonecrosis and posttraumatic arthritis was ascertained. Foot Function Index and Musculoskeletal Function Assessment questionnaires were completed.

Results: Thirty-eight patients were evaluated after an average duration of follow-up of thirty-three months. Early complications occurred in eight patients. Ten of the twenty-six patients who had a complete set of radiographs had development of osteonecrosis of the talar body. Five of these ten patients experienced collapse of the talar dome at a mean of 10.2 months after surgery. All patients with a history of both an open fracture and osteonecrosis experienced collapse. Seventeen of twenty-six patients had posttraumatic arthritis of the tibiotalar joint, and nine of twenty-six had posttraumatic arthritis of the subtalar joint. Fractures of both the talar body and neck led to development of advanced arthritis more frequently than did fractures of the talar body only (p = 0.04). All patients with open fractures had end-stage posttraumatic arthritis (p = 0.053). Twenty-three (88%) of twenty-six patients had radiographic evidence of osteonecrosis and/or posttraumatic arthritis. Worse outcomes were noted in association with comminuted and open fractures. Osteonecrosis and posttraumatic arthritis adversely affected outcome scores.

Conclusions: Open reduction and internal fixation of talar body fractures may restore congruity of the adjacent joints. However, early complications are not infrequent, and most patients have development of radiographic evidence of osteonecrosis and/or posttraumatic arthritis. Associated talar neck fractures and open fractures more commonly result in osteonecrosis or advanced arthritis. Worse functional outcomes are seen in association with advanced posttraumatic arthritis and osteonecrosis that progresses to collapse. It is important to counsel patients regarding these devastating injuries and their poor prognosis and potential complications.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?

Related articles in JBJS:

Surgical Treatment of Talar Body Fractures
Heather A. Vallier, Sean E. Nork, Stephen K. Benirschke, and Bruce J. Sangeorzan
JBJS 2004 86: 180-192. [Abstract] [Full Text]  



This article has been cited by other articles:


Home page
 JBJSHome page
C. S. Smith, S. E. Nork, and B. J. Sangeorzan
The Extruded Talus: Results of Reimplantation
J. Bone Joint Surg. Am., November 1, 2006; 88(11): 2418 - 2424.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
D. P. Barei, S. E. Nork, W. J. Mills, C. P. Coles, M. B. Henley, and S. K. Benirschke
Functional Outcomes of Severe Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plates
J. Bone Joint Surg. Am., August 1, 2006; 88(8): 1713 - 1721.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
R. A. Miller, T. A. DeCoster, and M. S. Mizel
What's New in Foot and Ankle Surgery?
J. Bone Joint Surg. Am., April 1, 2005; 87(4): 909 - 917.
[Full Text] [PDF]

Home page
 JBJSHome page
I. F. Rubel and A. Carrer
Fresh-Frozen Osteochondral Allograft Reconstruction of a Severely Fractured Talus. A Case Report
J. Bone Joint Surg. Am., March 1, 2005; 87(3): 625 - 629.
[Full Text] [PDF]

Home page
 JBJSHome page
P. A. Cole and M. Bhandari
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am., December 1, 2004; 86(12): 2782 - 2795.
[Full Text] [PDF]

Home page
 JBJSHome page
E. Lindvall, G. Haidukewych, T. DiPasquale, D. Herscovici Jr., and R. Sanders
Open Reduction and Stable Fixation of Isolated, Displaced Talar Neck and Body Fractures
J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2229 - 2234.
[Abstract] [Full Text] [PDF]