Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck Fractures Versus Fixation of Talus Neck Fractures with Concomitant Ipsilateral Foot and Ankle Fractures
Keywords:
Avascular Necrosis, Hawkins Classification, Open Reduction and Internal Fixation, Outcome, Talus NeckAbstract
ABSTRACT
OBJECTIVES
This study aimed to compare the radiological and functional outcomes of open reduction and internal fixation of isolated Talus neck fractures with Talus neck ipsilateral foot and ankle fractures.
METHODOLOGY
This retrospective study was conducted in the Orthopaedics Division, Lady Reading Hospital, Peshawar. The medical records of Talus neck fractures fulfilling the inclusion criteria and operated on in the last five years were reviewed. Patients were divided into group A (isolated Talus neck fractures) and group B (Talus neck fracture with concomitant ipsilateral foot and ankle fractures). Postoperative radiological fracture union, osteoarthritis, avascular necrosis (AVN) and functional outcome using the American Orthopaedic Foot and Ankle Society (AOFAS) were assessed and compared in both groups.
RESULTS
34 patients, with 18 (52.94%) patients in group A and 16 (47.05%) in group B. The mean AOFAS score at one year was 95.34±3.3 in group A and 74.11±2.2 in group B (P=0.001). Non-union was noted in 1(6.25%) patient in group B and none in group A. AVN Talus was documented in 02(11.11%) patients in group A and 07(43.75%) in group B(P=0.02). Postoperative osteoarthritis was noted in 3(16.66%) patients in group A and 5(31.25%) in group B. Multivariate regression analysis revealed that smoking, concomitant ipsilateral foot and ankle fractures, fracture classification and quality of postoperative fracture reduction were significant predictors of increased postoperative AVN of the Talus.
CONCLUSION
Open reduction and internal fixation of isolated Talus neck fractures have significantly better radiological and functional outcomes than fixation of Talus fractures with concomitant ipsilateral foot and ankle fractures.
Downloads
Metrics
References
Saravi B, Lang G, Ruff R, Schmal H, Südkamp N, Ülkümen S, et al. Conservative and surgical treatment of talar fractures: a systematic review and meta-analysis on clinical outcomes and complications. Int J Environ Res Public Health. 2021;18(16):8274. doi:10.3390/ijerph18168274. PMID: 34444022
Coltart WD. Aviator's astragalus. J Bone Joint Surg Br. 1952;34-B(4):545-566. doi:10.1302/0301-620X.34B4.545. PMID: 12999945
Jermander E, Sundkvist J, Ekelund J, Möller M, Wolf O, Mukka S. Epidemiology, classification, treatment and mortality of talus fractures: an observational study of 1794 talus fractures from the Swedish Fracture Register. Foot Ankle Surg. 2022;28(8):1444-1451. doi:10.1016/j.fas.2022.08.008. PMID: 36028442
Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014;96(3):192-197. doi:10.2106/JBJS.L.01680. PMID: 24500580
Kumar R, Kumar A, Shanker A, Kumar R. Talar fractures treated with closed reduction and percutaneous screw fixation. J Orthop Dis Traumatol. 2023;6(3):213-217. doi:10.4103/jodp.jodp_84_23
Al-Jabri T, Muthian S, Wong K, Charalambides C. Talus fractures: all I need to know. Injury. 2021;52(11):3192-3199. doi:10.1016/j.injury.2021.10.008. PMID: 34740388
Githens M, Tangtiphaiboontana J, Carlock K, Campbell ST. Talus fractures: an update on current concepts in surgical management. J Am Acad Orthop Surg. 2022;30(15). doi:10.5435/JAAOS-D-20-01348. PMID: 35862213
Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, et al. Total talar fracture—long-term results of internal fixation of talar fractures: a multicentric study of 114 cases. Orthop Traumatol Surg Res. 2012;98(4 Suppl). doi:10.1016/j.otsr.2012.04.012. PMID: 22621831
Srinath A, Southall WGS, Nazal MR, Mechas CA, Foster JA, Griffin JT, et al. Talar neck fractures with associated ipsilateral foot and ankle fractures have a higher risk of avascular necrosis. J Orthop Trauma. 2024;38(6):220-224. doi:10.1097/BOT.0000000000002798. PMID: 38457751
Jordan RK, Bafna KR, Liu J, Ebraheim NA. Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg. 2017;56(4):817-821. doi:10.1053/j.jfas.2017.04.013. PMID: 28633784
Day MA, Compton JT, Buckwalter JA 5th. Leland G. Hawkins, MD—his life and orthopaedic legacy: talus fractures and the Hawkins classification. Iowa Orthop J. 2018;38:1-8. PMID: 30104918
Lindvall E, Haidukewych G, DiPasquale T, Herscovici D Jr, Sanders R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004;86(10):2229-2234. doi:10.2106/00004623-200410000-00014. PMID: 15466732
Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007;46(2):65-74. doi:10.1053/j.jfas.2006.12.002. PMID: 17331864
Taş SK, Aydın A. Combined ipsilateral fracture of the tibial shaft, lateral malleolus, and talar neck: a case report. Trauma Case Rep. 2026;61:101315. doi:10.1016/j.tcr.2026.101315. PMID: 41909214
Kumar SV, Baskar AA, Sathyendra KG, Vasagan R, Solankey RD, Venkatesh R. A rare case of talus neck and open medial malleolus fractures with ankle subluxation treated using a single anteromedial approach. J Orthop Case Rep. 2025;15(9):277-281. doi:10.13107/jocr.2025.v15.i09.6098. PMID: 40936834
Zhang Y, Chen Y, Zhou K, Ma H, Zhu L. Talar neck fracture combined with comminuted medial malleolar fracture: a case report. Medicine (Baltimore). 2025;104(45). doi:10.1097/MD.0000000000045848. PMID: 41204519
Daryoush JR, Sato EH, Rothberg DL, Higgins TF, Haller JM, Marchand LS. The combined talus and sustentaculum fracture: a case series. Injury. 2024;55(10):111766. doi:10.1016/j.injury.2024.111766. PMID: 39106534
Zhang J, Xu J, Yu J, Chen H, Hong X, Zhang S, et al. Predicting the risk of postoperative avascular necrosis in patients with talar fractures based on an interpretable machine learning model. Front Bioeng Biotechnol. 2025;13:1644261. doi:10.3389/fbioe.2025.1644261. PMID: 40821667
Zhang C, Zhu J, Jia J, Guan Z, Sun T, Zhang W, et al. Effect of single versus multiple fractures on systemic bone loss in mice. J Bone Miner Res. 2021;36(3):567-578. doi:10.1002/jbmr.4211. PMID: 33181861
Zheng J, Yao Z, Xue L, Wang D, Tan Z. The role of immune cells in modulating chronic inflammation and osteonecrosis. Front Immunol. 2022;13:1064245. doi:10.3389/fimmu.2022.1064245. PMID: 36582244
Kondo T, Nakano Y, Adachi S, Murohara T. Effects of tobacco smoking on cardiovascular disease. Circ J. 2019;83(10):1980-1985. doi:10.1253/circj.CJ-19-0323. PMID: 31462607
Sautet P, Roussignol X, Loubignac F, Rochwerger RA, Pidhorz L; Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT). Talar fracture: epidemiology, treatment and results in a multicenter series. Orthop Traumatol Surg Res. 2021;107(6):102835. doi:10.1016/j.otsr.2021.102835. PMID: 33524630
Alley MC, Vallier HA, Tornetta P 3rd; Orthopaedic Trauma Research Consortium. Identifying risk factors for osteonecrosis after talar fracture. J Orthop Trauma. 2024;38(1):25-30. doi:10.1097/BOT.0000000000002706. PMID: 37735752
Roddy E, Hannay W, Khilfeh B, Newell K, Dalstrom D, Sangeorzan B, et al. Long-term functional outcomes after modern surgical treatment of talus fractures: a 10-year single center cohort study. Foot Ankle Int. 2025;46(11):1218-1228. doi:10.1177/10711007251355611. PMID: 40922107
Lee C, Brodke D, Perdue PW Jr, Patel T. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2020;28(20). doi:10.5435/JAAOS-D-20-00116. PMID: 33030854
Lee JY, Ryu JH, Kook JM, Oh JS. Midterm outcomes after operative management of Hawkins type III talar neck fractures. Clin Orthop Surg. 2024;16(3):470-476. doi:10.4055/cios23391. PMID: 38827753
Parmeshwar SS, Sharma SL, Sharma A, Shetty A, Kiran BM, Patil S. A comparative study of three different approaches in treatment of talar neck fractures. J Clin Orthop Trauma. 2022;37:102092. doi:10.1016/j.jcot.2022.102092. PMID: 36711112
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Faaiz Ali Shah, Aimal Sattar, Zia Ullah Jan
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
