UNASSIGNED: To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral \"safe zone\" for Hawkins type Ⅰ-Ⅲ talar neck fractures.
UNASSIGNED: A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral \"safe zone\" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.
UNASSIGNED: The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients\' satisfaction in the study group were significantly better than those in the control group ( P<0.05).
UNASSIGNED: The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral \"safe zone\" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
UNASSIGNED: 探讨经后外侧“安全区”行平行螺钉内固定治疗HawkinsⅠ～Ⅲ型距骨颈骨折的临床疗效。.
UNASSIGNED: 回顾分析2019年1月—2021年6月收治且符合选择标准的35例距骨颈骨折患者临床资料。根据手术方式分为研究组（14例，采用经皮后外侧“安全区”行平行螺钉内固定）和对照组（21例，采用传统切开复位前路交叉螺钉内固定）。两组患者性别、年龄、侧别、骨折Hawkins分型及受伤至手术时间等基线资料比较差异均无统计学意义（ P>0.05）。记录两组患者手术时间、骨愈合时间、并发症发生情况及Hawkins征情况；末次随访时采用疼痛视觉模拟评分（VAS）及美国矫形足踝协会（AOFAS）踝与后足评分评价患者疼痛及功能改善情况；采用健康调查12项简表（SF-12）评分评估整体生活质量，分为躯体及心理两部分评分；采用5分李克特量表法对患者满意度进行评价。.
UNASSIGNED: 研究组手术时间短于对照组，差异有统计学意义（ P<0.05）。所有患者均获随访，随访时间13～35个月，平均20.6个月；两组随访时间比较差异无统计学意义（ P>0.05）。研究组骨愈合时间显著短于对照组，Hawkins征阳性率（83.33%）显著高于对照组（33.33%），差异均有统计学意义（ P<0.05）。对照组术后发生切口延迟愈合2例、骨缺血性坏死7例、关节退变3例、骨不连1例、内固定物激惹3例，研究组仅发生2例关节退变，两组并发症发生率比较差异有统计学意义（ P<0.05）。末次随访时，两组VAS评分比较差异无统计学意义（ P>0.05），但研究组SF-12躯体和心理评分、AOFAS踝与后足评分以及患者满意度均优于对照组，差异有统计学意义（ P<0.05）。.
UNASSIGNED: 经后外侧“安全区”行平行螺钉内固定治疗HawkinsⅠ～Ⅲ型距骨颈骨折可获得比传统开放手术更好的临床疗效，具有创伤小、并发症少、恢复快、患者满意度高的优势。.

BACKGROUND: Fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. In the present study, we report a surgical treatment of Hawkins type III talar neck fracture through the approach of medial malleolar osteotomy and mini-plate for fixation and discuss the therapeutic effects after long-term follow-up.
METHODS: From January 2010 to January 2015, 21 patients with 22 fractures were treated using this approach within days of sustaining the injury. Clinical and radiographic data were collected during regular post-operative follow-ups. Health-related quality of life factors were evaluated using visual analogue scale (VAS). Functional outcomes were determined according the Hawkins score and the Ankle-Hind foot Scale of the American Orthopedic Foot and Ankle Society (AOFAS). Present of complications such as arthritis, avascular necrosis (AVN), and malunion were evaluated using radiographs and magnetic resonance imaging (MRI). Anatomical parameters of injured and corresponding uninjured talus were measured and compared using digital three-dimensional (3D) computer model.
RESULTS: The mean duration of surgery was 65.6 ± 9.7 min. The average blood loss volume of the patients was 29.1 ± 5.7 ml. All the patients except 1 were followed up 18 to 41 months (average 29.6 months). The average VAS score for these patients was 3.2 ± 1.1, and the mean Hawkins score was 11.4 ± 3.4 at the final follow-up visit. The average AOFAS score was 72.8 ± 17.3. Nine patients outcomes were rated as \"excellent\", 4 as \"good\", 4 as \"fair,\" and 4 as \"poor\". No malunion, screw loosening, plate breakage, or other internal fixation failures were found at final follow-up. Long-term complications included: 1 case of malunion, 5 cases of complete AVN, 8 cases of partial AVN, 13 cases of talocrural arthritis, 14 cases of subtalar arthritis, and 3 cases of talonavicular arthritis. Secondary surgery was performed in 4 cases. The relevant average anatomical data of injured and uninjured talus show no significant difference.
CONCLUSIONS: This surgical treatment we used here resulted in decreased soft tissue trauma, adequate exposure of talar neck, satisfactory performance of daily life activities, and quality of life following surgery and restoration of anatomy of injured talus. However, long-term complications such as arthritis and AVN are still commonly seen.

OBJECTIVE: To investigate the optimal posterior screw placement and the geometry of safe zones for screw insertion in the talar neck.
METHODS: Computed tomography data for 15 normal feet were imported into Mimics 10.01 software for 3-dimensional reconstruction; 4.0-mm-diameter screws were simulated from the lateral tubercle of the posterior process of the talus to the talar head. The range of screw paths trajectories and screw lengths at nine locations that did not breach the cortex of the talus were evaluated. In addition, the farthest (point a) and nearest point (point b) of the safe zone to the subtalar joint at each location, the anteversion angle (angle A), which is parallel to the sagittal plane, and the horizontal angle (angle B), which is perpendicular to the sagittal plane, were measured.
RESULTS: The safe zone was mainly between the 30% location and the 60% location; the width of each safe zone was 13.6° ± 1.4°; the maximum height of each safe zone was 7.8° ± 1.2°. The height of the safe zone was lowest at the 30% location (4.5°) and highest at the 50% location (7.3°). The mixed safe zone of all tali was between the 50% location and the 60% location. When a screw was inserted at point a, the safe entry distance (screw length) ranged from 48.8 to 49.5 mm, and when inserted to point b, the distance ranged from 48.2 to 48.9 mm. And inserting a 48.7 mm screw, 5.6° laterally and 7.4° superiorly, from the lateral tubercle of the posterior process of the talus towards the talar head is safest.
CONCLUSIONS: The safe zone of posterior screw fixation have been defined applying to most talus, assuming the fractures are well reduced, this may strengthen the stability, shorten the operation time and reduce the incidence of surgical complications.

BACKGROUND: The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures.
METHODS: Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated.
RESULTS: The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures.
CONCLUSIONS: The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases.
METHODS: Level III, comparative case series.