[Complete transverse fractures of the talus: value of magnetic resonance imaging for detection of avascular necrosis].
The authors report a series of 32 complete transverse fractures of the neck or body of the talus. The fractures occurred mostly in young males, as a result of motor vehicle accidents. The fracture line was transverse in the neck or body of the talus in 20 cases, sagittal in four and comminuted in eight cases. Using Hawkins' classification, there were 10 type I, 16 type II, and 6 type III fractures. The treatment was conservative in 8 cases and surgical in 24. The patients were evaluated clinically and radiologically with an average follow-up of 7 years. All patients underwent radiological study at follow-up and 17 underwent NMR evaluation. Eleven underwent NMR evaluation at final follow-up, and the other 6 early in their postoperative evolution. The postoperative results were evaluated based upon clinical and radiological criteria. The clinical result was good or very good in 37.5% of cases. Segmental necrosis of the talar body was noted in 6 cases and complete necrosis in 5, which required arthrodesis in 8 cases. Avascular necrosis is a common complication. Its frequency depends on the type and displacement of the fracture. If it becomes symptomatic, the only treatment is tibiotalar or tibiotalocalcaneal arthrodesis. The contribution of NMR is very important, as it gives the positive diagnosis as well as information regarding evolution. Complete transverse fractures of the talar neck or body are rare; their treatment only gives a little over one third good and very good results in the long term. NMR gives the diagnosis early and shows the extent of necrosis. It can have predictive value for the collapse risk and guide reeducation with or without weight bearing.
Service d'Orthopédie-Traumatologie, CHU Nord, Amiens, France.
O
O
Jarde
G
G
Boulu
E
E
Havet
A
A
Gabrion
P
P
Vives
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000145:classification / Q000150:complications* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000145:classification / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D011237:Predictive Value of Tests; D012307:Risk Factors; D013628:Talus / Q000293:injuries*