Goal is to minimize posttraumatic arthrosis of ankle and subtalar joint and maintain vascularity
The most stable biomechanical fixation for talar neck fractures is two parallel screws placed in an antegrade fashion from the posterolateral talar body into the anteromedial talar head, crossing the talar neck fracture. Histologically, this area of the talus has the most dense bone, allowing for improved screw purchase. (Swanson TV, ICL 39;1990:147).
Dorsomedial surface is often comminuted. Plantar and lateral surfaces are best used to judge reduction.
Consider medial malleolar osteotomy to improve medial exposure.
Plate fixation may provide more stable fixation, especially in fractures with significant comminution
Talar Neck Fracture ORIF Technique
Sign operative site.
Pre-operative antibiotics, +/- regional block.
General endotracheal anesthesia
Supine position. All bony prominences well padded.
Anterolateral and anteromedial approaches.
Prep and drape in standard sterile fashion.
Close in layers.
Talar Neck Fracture ORIF Complications
Osteonecrosis: diagnosis made by absence of Hawkins sign (lucency deep to the subchondral surface of the talar dome on an AP radiograph of the ankle 6-8 wks after injury which denotes revascularization.) ON does not always lead to collapse. Pts should be cautioned of potential collapse and followed closely.
6 Weeks: Evaluate for Hawkins Sign (subcondral lucency in the dome of the talus indicated revascularization).
Talar Neck Fracture ORIF Outcomes
62% anatomic reduction, 19% nearly anatomic reduction, 19% poor reduction. Overall union rate = 88%. 100% posttraumatic arthritis of the subtalar joint. 50% osteonecrosis overall. 86% osteonecrosis for open fractures.(Lindvall E, JBJS 2004;86A:2229).
Mean Ankle Society Ankle-Hindfoot Score = 71 +/- 19 out of 100 points (higher score better). Secondary reconstructive surgery = 24 +/- 5% at 1 year and 48 +/- 10% at 10 years postinjury (Sanders DW, JOT 2004;19:265).
Talar Neck Fracture ORIF Review References
Lemaire RG, Bustin W: Screw fixation of fractures of the neck of the talus using a posterior approach. J Trauma 1980;20:669-673.