Κατάγματα Αστραγάλου

A.X.Papadopoulos, M.Tyllianakis, E. Lambiris

EVALUATION AND TREATMENT OF

TALAR FRACTURES

Orthopeadic Department of Patras University

Head: Prof. E. Lambiris

ORTHO PATRAS

TALAR FRACTURES:

Dorsiflexion (extension) is the main

mechanism of injury

3% of all foot fractures

Arthritis is common: 70% of talus

surface is covered by cartilage

High likelihood of vascular interruption

ORTHO PATRAS

PATIENTS

12 (52,2%) multi-injured patients

Between 1992 and 2000, 25 patients with

talus fractures were treated

Mean age 31,8 y (16 - 64 y)

Follow-up: 23 patients [20 men-3 women]

ORTHO PATRAS

ΜΗΧΑΝΙΣΜΟΣ ΚΑΚΩΣΗΣ

15

8

Τροχαίο ατύχημα

Πτώση από ύψος

65,2%

34,7%

ORTHO PATRAS

Talar neck fracture 15 patients (65,2%)

CLASSIFICATION:

A B

C D

(Hawkins 1970 - Canale and Kelly’s modification 1978)

Talar body fracture(shearing) :

4 patients (17,4%)

Talar head fracture:

1 patient

Talar process fracture :3 patients

(13,1%)-posterior tubercle ORTHO PATRAS

RADIOLOGICAL EVALUATION

Foot-Ankle in 15% inversion

Talus CT (saggital,tranverse and coronal)

Foot-Ankle F+P

ORTHO PATRAS

Surgical treatment : 18 patients

TREATMENT

ORTHO PATRAS

Excellent: 11 patients

(47,8%)

Good: 5 patients

(21,7%)

Moderate: 3 patients

(16,6%)

Poor: 4 patients

(17,4%)

RESULTS

Mean folow-up : 58 months (12 months - 9 years)

FUNCTION (40)

GAIT (10)

RANGE OF MOTION (10)

SUMMARY (100)

Iowa Ankle evaluation score

FREEDOM FROM PAIN (40)

ORTHO PATRAS

2

2 1 1

5 1 1

0% 20% 40% 60% 80% 100%

poor

moderate

good

excellent

A

B

C

D

NECK # RESULTS

ORTHO PATRAS

1 1

1

1

2

0% 20% 40% 60% 80% 100%

poor

moderate

good

excellent

body

process

BODY-PROCESS-HEAD # RESULTS

ORTHO PATRAS

COMPLICATIONS

Arthritis

Avascular necrosis: 1 patient

Subtalar: 6 patients

Ankle: 2 patients

ORTHO PATRAS

Α.H. 19 years old,

neck # type A

and posterior

tubercle #

3/12 PO

6 /12 PO

ORTHO PATRAS

Κ.D. 64 y

neck #

type D

ORTHO PATRAS

3 years PO

Κ.D. PO

ORTHO PATRAS

P.T. 31y

body #

ORTHO PATRAS

P.T. 1,5 y PO

ankle arthritis-arthrodesis

ORTHO PATRAS

P.N. 25y, head #

4y PO

ORTHO PATRAS

H.B. 59y, neck # type B1,5 m PO

ORTHO PATRAS

H.B. 5m PO

ORTHO PATRAS

CONCLUSION

Immediated anatomical reduction with

internal fixation is essential for good results

after talus fractures

Undisplaced talus fractures can be treared

conservatively by immobilization and

close observation

Internal fixation using Herbert screw may

be a good alternative solution

ORTHO PATRAS