Abstract：
BACKGROUND: The operative treatment of high-grade talar neck fractures remains challenging, despite numerous previous reports. Our goal was to determine long-term outcomes and to establish a plan for management of postoperative complications (especially, avascular necrosis [AVN] of talar body) after high-grade talar neck fractures. We hypothesized that not every case with AVN of talar body require secondary surgical interventions.
METHODS: We retrospectively reviewed the radiographic and clinical findings of 14 patients who underwent operative treatment for high-grade talar neck fractures (modified Hawkins type III and IV) between January 2000 and December 2017. The minimum follow-up duration for inclusion was 3 years. Using radiographs during follow-up, we assessed the development of AVN of the talar body, malunion, nonunion, and posttraumatic osteoarthritis. Information about the secondary operations and their outcomes were also investigated using visual analogue scale (VAS) and American orthopaedic foot and ankle society (AOFAS) ankle-hindfoot scale at the final follow-up.
RESULTS: In 10 of 14 patients (71.4 %), talar body AVN developed during follow-up. However, secondary operation was required in only 30.0 % (3 of 10 patients). In the remaining 7 patients who did not undergo secondary operation, the symptoms were tolerable with a maximum of 89 months follow-up; although the talar body presented sclerotic changes, but without talar dome collapse. The rates of malunion and post-traumatic subtalar osteoarthritis were 21.4 % and 14.3 %, respectively. No patients presented with fracture site nonunion. After a mean of 55.86 ± 14.45 months (range, 37-89) follow-up, the final mean VAS and AOFAS scores were 3.07 ± 0.73 (range, 2-4) and 80.43 ± 3.11 (range, 75-85), respectively.
CONCLUSIONS: We recommend leaving talar body AVN untouched, unless the patient\'s symptoms become intolerable. In our clinical practice, postoperative AVN could be stably maintained without talar dome collapse for more than 7 years, although the sclerotic change persisted. Despite the small number of patients, our clinical experience may benefit patients with high-grade talar neck fractures and surgeons who treat such rare, serious, and challenging foot injuries.
METHODS: Level IV, Case series.
METHODS: We retrospectively reviewed the radiographic and clinical findings of 14 patients who underwent operative treatment for high-grade talar neck fractures (modified Hawkins type III and IV) between January 2000 and December 2017. The minimum follow-up duration for inclusion was 3 years. Using radiographs during follow-up, we assessed the development of AVN of the talar body, malunion, nonunion, and posttraumatic osteoarthritis. Information about the secondary operations and their outcomes were also investigated using visual analogue scale (VAS) and American orthopaedic foot and ankle society (AOFAS) ankle-hindfoot scale at the final follow-up.
RESULTS: In 10 of 14 patients (71.4 %), talar body AVN developed during follow-up. However, secondary operation was required in only 30.0 % (3 of 10 patients). In the remaining 7 patients who did not undergo secondary operation, the symptoms were tolerable with a maximum of 89 months follow-up; although the talar body presented sclerotic changes, but without talar dome collapse. The rates of malunion and post-traumatic subtalar osteoarthritis were 21.4 % and 14.3 %, respectively. No patients presented with fracture site nonunion. After a mean of 55.86 ± 14.45 months (range, 37-89) follow-up, the final mean VAS and AOFAS scores were 3.07 ± 0.73 (range, 2-4) and 80.43 ± 3.11 (range, 75-85), respectively.
CONCLUSIONS: We recommend leaving talar body AVN untouched, unless the patient\'s symptoms become intolerable. In our clinical practice, postoperative AVN could be stably maintained without talar dome collapse for more than 7 years, although the sclerotic change persisted. Despite the small number of patients, our clinical experience may benefit patients with high-grade talar neck fractures and surgeons who treat such rare, serious, and challenging foot injuries.
METHODS: Level IV, Case series.
摘要：
背景：高级别距骨颈骨折的手术治疗仍然具有挑战性，尽管以前有很多报道。我们的目标是确定长期结果并建立术后并发症的管理计划（尤其是，距骨的血管坏死[AVN]）在高级别距骨颈骨折后。我们假设并非每个距骨AVN病例都需要二次手术干预。
方法：我们回顾性回顾了2000年1月至2017年12月期间14例接受手术治疗的高级别距骨颈骨折（改良HawkinsIII型和IV型）患者的影像学和临床表现。纳入的最短随访时间为3年。在随访期间使用X光片，我们评估了距骨AVN的发育，malunion,骨不连,和创伤后骨关节炎。在最后的随访中，还使用视觉模拟量表（VAS）和美国骨科足踝协会（AOFAS）踝足-后足量表调查了有关二次手术及其结果的信息。
结果：在14例患者中有10例（71.4%），距体AVN在随访期间出现。然而,仅有30.0%需要二次手术(10例患者中有3例).其余7例未进行二次手术的患者,在最长89个月的随访中，症状是可以忍受的；尽管距骨出现了硬化变化，但没有距骨穹顶塌陷。畸形愈合和创伤后距下骨关节炎的发生率分别为21.4%和14.3%,分别。无患者出现骨折部位骨不连。平均55.86±14.45个月后(范围，37-89)后续行动，最终平均VAS和AOFAS评分为3.07±0.73(范围，2-4）和80.43±3.11（范围，75-85），分别。
结论：我们建议保持距骨AVN不变，除非患者的症状变得难以忍受。在我们的临床实践中，术后AVN可稳定维持7年以上，无距骨塌陷，尽管硬化改变持续存在。尽管患者人数很少，我们的临床经验可能会使高度距骨颈骨折患者和治疗这种罕见骨折的外科医生受益，严肃,挑战脚部受伤。
方法：四级，案例系列。
方法：我们回顾性回顾了2000年1月至2017年12月期间14例接受手术治疗的高级别距骨颈骨折（改良HawkinsIII型和IV型）患者的影像学和临床表现。纳入的最短随访时间为3年。在随访期间使用X光片，我们评估了距骨AVN的发育，malunion,骨不连,和创伤后骨关节炎。在最后的随访中，还使用视觉模拟量表（VAS）和美国骨科足踝协会（AOFAS）踝足-后足量表调查了有关二次手术及其结果的信息。
结果：在14例患者中有10例（71.4%），距体AVN在随访期间出现。然而,仅有30.0%需要二次手术(10例患者中有3例).其余7例未进行二次手术的患者,在最长89个月的随访中，症状是可以忍受的；尽管距骨出现了硬化变化，但没有距骨穹顶塌陷。畸形愈合和创伤后距下骨关节炎的发生率分别为21.4%和14.3%,分别。无患者出现骨折部位骨不连。平均55.86±14.45个月后(范围，37-89)后续行动，最终平均VAS和AOFAS评分为3.07±0.73(范围，2-4）和80.43±3.11（范围，75-85），分别。
结论：我们建议保持距骨AVN不变，除非患者的症状变得难以忍受。在我们的临床实践中，术后AVN可稳定维持7年以上，无距骨塌陷，尽管硬化改变持续存在。尽管患者人数很少，我们的临床经验可能会使高度距骨颈骨折患者和治疗这种罕见骨折的外科医生受益，严肃,挑战脚部受伤。
方法：四级，案例系列。
