Pierre Sautet1, Xavier Roussignol2, François Loubignac3, Richard-Alexandre Rochwerger4, Laurent Pidhorz5. 1. Chirurgie orthopédique et traumatologie, Centre Hospitalier Inter-communal Toulon/La Seyne, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France. Electronic address: sautetp@gmail.com. 2. Clinique du Cèdre, 950 rue de la Haie, 76230 Bois Guillaume, France. 3. Chirurgie orthopédique et traumatologie, Centre Hospitalier Inter-communal Toulon/La Seyne, 54 Rue Henri Sainte-Claire Deville, 83100 Toulon, France. 4. Chirurgie orthopédique et traumatologie, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France. 5. Chirurgie orthopédique et traumatologie, Centre Hospitalier du Mans, 194 Avenue Rubillard, 72037, Le Mans.
Abstract
INTRODUCTION: Talar fracture is rare. Treatment is surgical for neck and/or body fractures with displacement. The aims of the present study were to collect epidemiological data on talar fractures, and to assess the impact of trauma via various functional scores and radiographic impact in the medium term. HYPOTHESIS: Displaced talar fracture shows negative medium-term functional and radiological/clinical impact. MATERIAL AND METHODS: A multicenter retrospective study was performed with a minimum follow-up of 12 months post-trauma. Inclusion criteria included radiographic assessment at a minimum 12 months post-trauma and data on 3 functional scores: SF12, AOFAS and FAAM. 225 patients were initially included, 81 of whom had follow-up with functional and radiological/clinical assessment. RESULTS: Fracture reduction was anatomic in 61% of cases when CT was performed; reduction quality was independent of approach (p>0.05). 45% of patients showed subtalar osteoarthritis at a mean 2 years, significantly related to reduction defect (p<0.05). Mean AOFAS score was acceptable, at 74/100. Factors for functional prognosis comprised: reduction quality, hindfoot alignment, subtalar osteoarthritis, and talar osteonecrosis with dome collapse. DISCUSSION: Talar fracture led to late complications with socioeconomic impact. Subtalar osteoarthritis affects almost half of patients within some months of trauma. Optimal reduction is the key to fair progression. Postoperative CT assessment now seems mandatory. LEVEL OF EVIDENCE: IV; multicenter retrospective study.
INTRODUCTION:Talar fracture is rare. Treatment is surgical for neck and/or body fractures with displacement. The aims of the present study were to collect epidemiological data on talar fractures, and to assess the impact of trauma via various functional scores and radiographic impact in the medium term. HYPOTHESIS: Displaced talar fracture shows negative medium-term functional and radiological/clinical impact. MATERIAL AND METHODS: A multicenter retrospective study was performed with a minimum follow-up of 12 months post-trauma. Inclusion criteria included radiographic assessment at a minimum 12 months post-trauma and data on 3 functional scores: SF12, AOFAS and FAAM. 225 patients were initially included, 81 of whom had follow-up with functional and radiological/clinical assessment. RESULTS:Fracture reduction was anatomic in 61% of cases when CT was performed; reduction quality was independent of approach (p>0.05). 45% of patients showed subtalar osteoarthritis at a mean 2 years, significantly related to reduction defect (p<0.05). Mean AOFAS score was acceptable, at 74/100. Factors for functional prognosis comprised: reduction quality, hindfoot alignment, subtalar osteoarthritis, and talar osteonecrosis with dome collapse. DISCUSSION: Talar fracture led to late complications with socioeconomic impact. Subtalar osteoarthritis affects almost half of patients within some months of trauma. Optimal reduction is the key to fair progression. Postoperative CT assessment now seems mandatory. LEVEL OF EVIDENCE: IV; multicenter retrospective study.