PDF(Pubmed)
Abstract：
OBJECTIVE: The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures.
METHODS: The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system.
RESULTS: The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%).
CONCLUSIONS: The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon\'s thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.
METHODS: The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system.
RESULTS: The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%).
CONCLUSIONS: The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon\'s thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.
摘要：
目的：距骨颈和/或身体骨折的治疗是困难和具有挑战性的，对患者的长期功能结局有显著影响。优化管理，包括手术入路和植入物的选择，仍在不断讨论中。目的探讨外侧微型钢板联合内侧拉力螺钉治疗复杂中央距骨骨折的临床效果。
方法：回顾性分析2019年6月至2021年1月收治的8例复杂中央距骨骨折患者的临床资料。有六个男性和两个女性，年龄从15岁到66岁，平均年龄为37.4岁。左边有三例，右边有五例。所有骨折都是粉碎性的,其中距骨颈伴距体骨折7例，距体粉碎性距下关节半脱位1例。所有患者均采用前内侧联合前外侧入路，距骨外侧微型钢板固定和内侧拉力螺钉固定。骨折复位质量,工会时间,记录并发症，使用美国骨科足踝协会（AOFAS）评分系统评估功能结局。
结果：从受伤到手术的时间为1-6天，平均3.38天。随访时间34～53个月,平均44.88个月。所有骨折均愈合，平均愈合时间为16.75周（13-23周）。在6例中观察到解剖复位，在2例中观察到近。手术后,植入物没有松动或断裂，骨折复位丢失，内固定对皮肤和软组织的刺激。AOFAS平均得分为87.38（48-100），有五个优秀的案例，好的两个案例，差的一个案例，优良率为87.5%。一个手术切口的浅表皮肤坏死在换药后愈合。无深部感染发生。1例（1/8，12.5％）发生距骨缺血性坏死，无塌陷。外伤性关节炎4例(4/8,50%)。
结论：外侧微型钢板结合内侧螺钉治疗复杂中央距骨骨折，复位满意，固定稳定。减轻与减少不良相关的并发症。然而,由于没有解剖微型板，预轮廓是必要的，当应用侧板。这需要外科医生彻底熟悉距骨的解剖形态和熟练的手术技术。创伤性关节炎是复杂中央距骨骨折最常见的并发症。
方法：回顾性分析2019年6月至2021年1月收治的8例复杂中央距骨骨折患者的临床资料。有六个男性和两个女性，年龄从15岁到66岁，平均年龄为37.4岁。左边有三例，右边有五例。所有骨折都是粉碎性的,其中距骨颈伴距体骨折7例，距体粉碎性距下关节半脱位1例。所有患者均采用前内侧联合前外侧入路，距骨外侧微型钢板固定和内侧拉力螺钉固定。骨折复位质量,工会时间,记录并发症，使用美国骨科足踝协会（AOFAS）评分系统评估功能结局。
结果：从受伤到手术的时间为1-6天，平均3.38天。随访时间34～53个月,平均44.88个月。所有骨折均愈合，平均愈合时间为16.75周（13-23周）。在6例中观察到解剖复位，在2例中观察到近。手术后,植入物没有松动或断裂，骨折复位丢失，内固定对皮肤和软组织的刺激。AOFAS平均得分为87.38（48-100），有五个优秀的案例，好的两个案例，差的一个案例，优良率为87.5%。一个手术切口的浅表皮肤坏死在换药后愈合。无深部感染发生。1例（1/8，12.5％）发生距骨缺血性坏死，无塌陷。外伤性关节炎4例(4/8,50%)。
结论：外侧微型钢板结合内侧螺钉治疗复杂中央距骨骨折，复位满意，固定稳定。减轻与减少不良相关的并发症。然而,由于没有解剖微型板，预轮廓是必要的，当应用侧板。这需要外科医生彻底熟悉距骨的解剖形态和熟练的手术技术。创伤性关节炎是复杂中央距骨骨折最常见的并发症。
