TALUS FRACTURES - CLINICAL OUTCOMES - CLOSED REDUCTION AND MINIMAL INVASIVE OSTEOSYNTHESIS VERSUS OPEN REDUCTION AND INTERNAL FIXATION

Cristina Cocor1, D. M. Rădulescu1, A.R. Rădulescu1,2, A. Bădilă1

1Orthopaedics Clinic II , The Emergency Universitary Hospital, Bucharest, Romania
2The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Corresponding author: Dragoş-Mihai Rădulescu
Phone no. 0040722594588
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

The purpose of this paper is to evaluate and compare the clinical outcomes of closed reduction with minimal invasive osteosynthesis with the ones of open reduction with internal fixation in talus fractures. In this study we used the Bucharest University Hospital, Department of Orthopaedics and Traumatology database. We retrospectively reviewed the records of 65 patients with 70 talus fractures, 5 of them were bilateral) managed in our department between 2010-2013. The 65 patients were divided into two groups. In the first group, there were 26 patients with 27 talus fractures who were treated by closed reduction under C-arm control followed by minimal invasive osteosynthesis. We compared the results with the ones of the second group of 39 patients who had 43 talus fractures who were treated by open reduction with internal fixation. The mean age was 32.5 years (range: 22-79) for the first group and 35.1 years (range: 20–85). The gender distribution was 15 males/11 females for the first group and 27 males/12 females for the second group. The average follow-up was 4 years (range 2-7.3years). To evaluate properly the clinical outcome, we determined the American Foot and Ankle Score at 3,6,12 months and every year after that and we recorded the complications for each case: avascular necrosis, tibiotalar osteoarthritis and talocalcanean osteoarthritis. By groups, the complications were: for Group 1: avascular necrosis – 2, tibiotalar osteoarthritis – 1, talocalcanean osteoarthritis - 3, and for Group 2: avascular necrosis – 4, tibiotalar osteoarthritis – 1, talocalcanean osteoarthritis – 4. Group 1 had an average value of the American Foot and Ankle Score at of 85.6 +/- 9.2 (extremes: 54-96) at 3 months, of 89.4+/-8.9 (extremes:61-97) at 6 months and of 94.5 +/-8.8 (extremes: 64-100) at 1 year, while in Group 2 the average value for the American Foot and Ankle Score was 73.9 +/- 9,6 (extremes: 50-91) at 3 months, 82.1+/-7,6 (extremes: 55-90) at 6 months and of 89.5 +/-8,7 (extremes: 60-94) at 1 year. Talar fractures are most commonly followed by complications as osteoarthritis of the adjacent joints and avascular necrosis of the talus. Tibiotalar and talocalcanean osteoarthritis are well tolerated by patients, and the postoperative recovery is considerably faster in the case of closed reduction with minimally invasive osteosynthesis.

Keywords:talus fracture, avascular necrosis, osteoarthritis, minimally invasive osteosynthesis

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