title: Treatment of Hawkins type II fractures of talar neck by a vascularized cuboid pedicle bone graft and combined internal and external fixation: a preliminary report on nine cases.
abstract: BACKGROUND
  Fractures of the talar neck are relatively uncommon. The reported rates of avascular necrosis in Hawkins type II fractures vary from 34% to 50%. Various strategies have been adapted to prevent the occurrence of avascular necrosis.
  
  
  METHODS
  We retrospectively reviewed the records of nine patients with Hawkins type II fractures. Open reduction and internal fixation with percutaneous cannulated screws were performed, and external fixation was used to unload the talus. A vascularized cuboid pedicle bone graft based on the lateral tarsal artery is adapted to improve the blood supply to the talar body. Postoperative radiographs were used to evaluate the adequacy of the reduction and the process of fracture healing. Osteonecrosis was defined on plain radiographs as any area of increased density of the talar dome relative to the adjacent structures. The postoperative global foot function was assessed using the Maryland Foot Rating Score.
  
  
  RESULTS
  The average length of follow-up was 39 months (range, 16-58 months). The mean time to fixation was 54.4 hours. In all of the cases, the wound was closed primarily, and there were no postoperative infections or skin necrosis. Fractures healed uneventfully in all the patients with an average time to union as 15.6 weeks (range, 13-18 weeks). The avascular necrosis rate of talus was 0%. Hawkins sign was seen in one patient at 8 weeks after surgery in the anteroposterior view. According to the Maryland Foot Rating Score, excellent result (90-100) in seven cases and good result (75-89) in two cases were seen.
  
  
  CONCLUSIONS
  The use of a vascularized cuboid pedicle bone graft and combined internal and external fixation can effectively prevent avascular necrosis of the talus in preliminary study. Further randomized control research is necessary to clarify the effectiveness of this technique.
authors.affiliation: Department of Orthopaedics, Changhai Hospital, The Second Military Medical University, Shanghai, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Tang
authors.forename: Kaiwei
authors.initials: K
authors.lastname: Han
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Qiulin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Yang
authors.initials: Y
authors.lastname: Xie
authors.forename: Xuri
authors.initials: X
authors.lastname: Tang
authors.forename: Hao
authors.initials: H
authors.lastname: Xu
authors.forename: Ningfang
authors.initials: N
authors.lastname: Mao
mesh_terms: D016512:Ankle Injuries / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D016025:Bone Transplantation; D016267:External Fixators; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000517:prevention & control; D010521:Periosteum / Q000098:blood supply*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D011859:Radiography; D013524:Surgical Flaps / Q000098:blood supply*; D013628:Talus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*