Abstract：
OBJECTIVE: Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion.
METHODS: A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient\'s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM.
RESULTS: Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.
CONCLUSIONS: FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.
METHODS: A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient\'s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM.
RESULTS: Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.
CONCLUSIONS: FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.
摘要：
目的：开放性距骨骨折很难处理，它们通常与高水平的并发症有关，包括不愈合，缺血性坏死和感染。目前,此类伤害的管理基于BOAST4指南，尽管没有建议的明确管理，因此，最终的管理是基于外科医生的偏好。开放性距骨骨折治疗的关键原则是早期清创，整形伤口护理,解剖复位和最终固定尽可能。然而,在开放性距骨骨折/脱位并进行胫骨骨融合术后，是否应保留或切除距骨存在很多争论。
方法：回顾了2014年至2021年开放性距骨骨折的电子医院记录，其中14例患者为15例开放性距骨骨折。七个病例最初是用ORIF管理的，有5个病例是用融合治疗的，而其他人则用替代方法管理。我们收集了病人的年龄,性别,手术并发症,手术危险因素和治疗后功能能力和疼痛以及符合BOAST指南。该队列的平均随访时间为4年零1个月。使用EQ-5D-5L和FAAM-ADL/Sports评分作为患者报告的结果量度。使用软件PRISM分析数据。
结果：FUSION组和ORIF组之间的比较显示EQ-5D-5L评分无统计学差异（P=0.13），FAAM-ADL(P=0.20),FAAM-Sport（P=0.34），感染率（P=0.55），手术时间（P=0.91）和负重时间（P=0.39），尽管FUSION组多发伤和HawkinsIII和IV骨折的比例较高。
结论：FUSION通常用作ORIF或失败的ORIF的第二线。然而,缺乏直接比较明确接受FUSION或ORIF治疗的开放性距骨骨折患者结局的研究.我们的研究结果首次表明，FUSION在患者功能结局方面可能不逊于ORIF，感染率和生活质量，在开放性距骨骨折患者的管理中。值得注意的是，由于开放性距骨骨折增加了骨坏死和不愈合等并发症的风险，FUSION应被视为减轻这些患者的这些潜在并发症的可行选择。
方法：回顾了2014年至2021年开放性距骨骨折的电子医院记录，其中14例患者为15例开放性距骨骨折。
结果：FUSION组和ORIF组之间的比较显示EQ-5D-5L评分无统计学差异（P=0.13），
结论：FUSION通常用作ORIF或失败的ORIF的第二线。
