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Journal Club: Post-traumatic avascular necrosis in talar neck fractures with extension into the talar body

AAOS 2015 Presentation; Kevin Murr MD, Zack Unger MD, Jeremy Burnham MD, Raymond Wright MD, Eric Moghadamian MD

Background:

  • AVN is a well known complication of talar neck fractures and can be correlated with the Hawkins classification. Talar neck and body fractures do not commonly occur together
  • Purpose of study: (1) Determine effect on AVN rates of proximal extension of talar neck fracture into talar body. (2) determine if time to reduction, time to surgery, age, open versus closed fracture, patient smoking, or diabetes affected rates of AVN

Methods:

  • Retrospective review patients with talar neck fractures from 2008-2012 at UK. (n=103) Patients over 18 were reviewed. Fracture was classified according to modified Hawkins classification. Injury characteristics and concomitant injuries were recorded.
  • Fractures were classified as having proximal extension if they crossed a line representing the junction of the anterior talar body and lateral process with the neck.
  • Fractures underwent attempted reduction in ER with operative reduction if unsuccessful. Treating surgeon determined time to definitive fixation
  • ANV of talar body was determined via radiographs

Results:

  • 103 fractures with average age of 38. Ave follow-up of 13 months. 19 open, 28 with associated ankle fx, 5 with associated pilon. 43 smokers and 10 diabetics
  • 72 isolated talar neck fx’s and 31 with proximal extension. 15% ANV rate and 2% AVN with collapse.
  • Univariate analysis- proximal fracture extension and Hawkins III classification were only factors associated with increased AVN risk
    • Within fracture classifications, proximal extension was significantly associated with higher AVN rates in Type 2 and Type 2B’s
  • Categorical regression analysis revealed proximal fracture extension and Hawkins III classification were only factors associated with increased AVN risk (Hawkins 2B were trending to significance). Strongest predictor was proximal extension
  • Analysis of AVN patients revealed age was only factor significantly associated with collapse

Strengths:

  • Large number of fractures, clear clinical outcomes

Weaknesses

  • Retrospective, no validated scoring measures

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