Muhammad Zafar Iqbal Shahid, Muhammad Khalid, Tanveer Haider, Maqsood Akhtar, Siddique Hamid, Asim Islam.
Outcomes of open reduction and internal fixation of fracture of neck of talus.
Pak Postgrad Med J Jan ;33(3):56-61.

Background: Talus is the second largest tarsal bone with unique importance regarding its location and anatomy . It is an osseous link between foot and the leg and has got a pivotal role in overall foot function. It has got three important articulations at tibiotalar, talocalcaneal and talonavicular joint . It is divided into body, neck and posterior facets. Almost 70% surface of talus is covered with articular cartilage. Its blood supply is predominantly extraosseous and is at risk during fractures. Objectives: The aim of our study is to observe the long term outcomes after surgical treatment of fracture neck of talus. Study design: Prospective cross sectional study. Study setting: Department of Orthopedic Surgery Services hospital, Lahore Study duration: From Dec 2017 - Feb 2020 Methodology: After approval from hospital ethical review board, total number of 30 patients with fracture neck of talus, both males ( 20 patients ) and females ( 10 patients ) were included in the study. Each patient underwent X-rays of ankle joint AP, LAT and ankle mortis views .. All these fractures were fixed with 4 mm cannulated screw by using combined anterolateral and anteromedial approach. Results: Post-traumatic arthritis was observed in 15 patients (50.0%) out of the 30 patients with 10 (75.0 %) patients at subtalar joint and 5 (25.0 %) patients at ankle joint. Among these 30 patients, 8 (26.7%) patients were having Hawkins type 2, 14 (46.6%) with Hawkins type 3 and remaining 8 (26.7%) patients with were having Hawkins type 4 fractures. Osteonecrosis was mostly observed in Hawkins type 3 fractures 6 (42.8%) in Hawkins type 3, 2 (25.0%) patients in Hawkins type 2 fractures and 1 (12.5%) patient in Hawkins type 4 fractures. 1 (3.3 %) patient developed non-union and 1 (3.3 %) patient developed delayed union. 4(13.3 %) patients developed the superficial infection which was treated with IV antibiotics and wound irrigation . Conclusion: We concluded from our study that familiarity with the complex vascular, bony, surgical anatomy and techniques for rigid fixation of fractures is of utmost importance for fracture neck of talus. Rate of osteonecrosis, arthritis, mal-union and non-union are still high even in the presence of rigid internal fixation of these fractures

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