Abstract：
BACKGROUND: The sustentaculum tali is a biomechanically important stabilizer of the hindfoot and contributes to articular congruency of the subtalar joint. Sustentaculum injury associated with a talus fracture has been described infrequently and treatment of this combined injury varies. The purpose of this study was to describe and evaluate the outcomes of the combined talus and sustentaculum fracture.
METHODS: Retrospective chart and radiographic review was performed on all talus fractures (n = 436) requiring operative fixation over a 21-year period at a single Level-1 trauma center. All talus fractures with sustentaculum fractures were included. Statistical analysis was performed using Chi-squared and Fishers exact tests where appropriate.
RESULTS: Sustentaculum fractures occurred in 6.2 % (n = 27) of patients with talus fractures. Average follow-up was 14 months; 18.5 % were open fractures, 88.8 % were from high-energy mechanisms, and 44.4 % were polytraumas. Diagnosis of the sustentaculum fracture was missed on presenting radiographs in 69.2 % (n = 18). The most common associated talus fracture was a talar neck fracture (40.7 %) and the majority (73.7 %) were Hawkins II. Overall, 40.7 % (n = 11) of the sustentaculum fractures were treated with independent fixation and 7.4 % (n = 2) were treated with acute subtalar arthrodesis. Subtalar post-traumatic osteoarthritis (PTOA) at final follow-up was seen in 23.1 % of combined injuries. Independent sustentaculum fixation did not influence the rate of PTOA or re-operation (p = 0.92, p = 0.91, respectively).
CONCLUSIONS: Talar fractures have an associated sustentaculum fracture in approximately 6 % of cases, especially with Hawkins II fracture-dislocations. Over two-thirds of the associated sustentaculum fractures were missed on presenting radiographs, reiterating the need for heightened awareness and consideration of advanced imaging for all talus fractures. The rate of PTOA following these combined injuries at mean follow-up of 24 months does not exceed established rates after isolated talus fractures. Further research is required to determine the optimal management of the sustentaculum in these combined injuries.
METHODS: IV.
METHODS: Retrospective chart and radiographic review was performed on all talus fractures (n = 436) requiring operative fixation over a 21-year period at a single Level-1 trauma center. All talus fractures with sustentaculum fractures were included. Statistical analysis was performed using Chi-squared and Fishers exact tests where appropriate.
RESULTS: Sustentaculum fractures occurred in 6.2 % (n = 27) of patients with talus fractures. Average follow-up was 14 months; 18.5 % were open fractures, 88.8 % were from high-energy mechanisms, and 44.4 % were polytraumas. Diagnosis of the sustentaculum fracture was missed on presenting radiographs in 69.2 % (n = 18). The most common associated talus fracture was a talar neck fracture (40.7 %) and the majority (73.7 %) were Hawkins II. Overall, 40.7 % (n = 11) of the sustentaculum fractures were treated with independent fixation and 7.4 % (n = 2) were treated with acute subtalar arthrodesis. Subtalar post-traumatic osteoarthritis (PTOA) at final follow-up was seen in 23.1 % of combined injuries. Independent sustentaculum fixation did not influence the rate of PTOA or re-operation (p = 0.92, p = 0.91, respectively).
CONCLUSIONS: Talar fractures have an associated sustentaculum fracture in approximately 6 % of cases, especially with Hawkins II fracture-dislocations. Over two-thirds of the associated sustentaculum fractures were missed on presenting radiographs, reiterating the need for heightened awareness and consideration of advanced imaging for all talus fractures. The rate of PTOA following these combined injuries at mean follow-up of 24 months does not exceed established rates after isolated talus fractures. Further research is required to determine the optimal management of the sustentaculum in these combined injuries.
METHODS: IV.
摘要：
背景：距下是后足的生物力学重要稳定器，有助于距下关节的关节一致性。很少描述与距骨骨折相关的Sustentaculum损伤，并且这种联合损伤的治疗方法各不相同。这项研究的目的是描述和评估距骨和跟风骨折的结果。
方法：对需要手术固定的所有距骨骨折（n=436）在一个1级创伤中心进行了21年的回顾性图表和影像学检查。包括所有的距骨骨折和支撑带骨折。在适当的情况下，使用卡方和Fishers精确测试进行统计分析。
结果：距骨骨折患者中6.2%(n=27)发生了上皮骨折。平均随访14个月，18.5%为开放性骨折，88.8%来自高能机制，44.4%为多发伤。69.2％（n=18）的X线片漏诊了连带骨折。最常见的距骨骨折是距骨颈骨折（40.7％），大多数（73.7％）是HawkinsII。总的来说,40.7％（n=11）的上肢骨折采用独立固定治疗，7.4％（n=2）采用急性距下关节固定术治疗。最终随访时的距下创伤后骨关节炎（PTOA）在23.1％的合并损伤中可见。独立的支撑固定不影响PTOA或再次手术的发生率（分别为p=0.92，p=0.91）。
结论：在大约6%的病例中，距骨骨折有伴发的连带骨折，尤其是HawkinsII型骨折脱位.超过三分之二的相关连带骨折在X线照片上被遗漏，重申需要提高所有距骨骨折的认识和考虑先进的成像。在24个月的平均随访中，这些合并损伤后的PTOA发生率不超过孤立的距骨骨折后的既定发生率。需要进一步的研究来确定在这些合并损伤中对支撑带的最佳管理。
方法：IV.
方法：对需要手术固定的所有距骨骨折（n=436）在一个1级创伤中心进行了21年的回顾性图表和影像学检查。包括所有的距骨骨折和支撑带骨折。在适当的情况下，使用卡方和Fishers精确测试进行统计分析。
结果：距骨骨折患者中6.2%(n=27)发生了上皮骨折。平均随访14个月，18.5%为开放性骨折，88.8%来自高能机制，44.4%为多发伤。69.2％（n=18）的X线片漏诊了连带骨折。最常见的距骨骨折是距骨颈骨折（40.7％），大多数（73.7％）是HawkinsII。总的来说,40.7％（n=11）的上肢骨折采用独立固定治疗，7.4％（n=2）采用急性距下关节固定术治疗。最终随访时的距下创伤后骨关节炎（PTOA）在23.1％的合并损伤中可见。独立的支撑固定不影响PTOA或再次手术的发生率（分别为p=0.92，p=0.91）。
结论：在大约6%的病例中，距骨骨折有伴发的连带骨折，尤其是HawkinsII型骨折脱位.超过三分之二的相关连带骨折在X线照片上被遗漏，重申需要提高所有距骨骨折的认识和考虑先进的成像。在24个月的平均随访中，这些合并损伤后的PTOA发生率不超过孤立的距骨骨折后的既定发生率。需要进一步的研究来确定在这些合并损伤中对支撑带的最佳管理。
方法：IV.
