title: Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases.
abstract: BACKGROUND
  Displaced talar neck and body fractures are rare and challenging for the surgeon. Results are often disappointing due to inadequate reduction or internal fixation and high rates of osteoarthritis and osteonecrosis. Very few published series describe the long-term results after internal fixation of talar factures. One of the goals of the 2011 SOO meeting symposium was to specifically evaluate the long-term results after internal fixation of talar fractures. This study included only central fractures.
  
  
  METHODS
  We reviewed the results of 114 central talar fractures that had been treated by internal fixation between 1982 and 2006 in nine hospitals in the Western part of France. The clinical and radiological follow-up was 111 months on average. All the patients with a radiological assessment had at least 5 years of follow-up.
  
  
  RESULTS
  Poor reduction was apparent in 33% of cases. The average Kitaoka score was 70/100, which corresponds to an average functional level. At the last follow-up evaluation, 34% of cases had osteonecrosis and 74% had peritalar osteoarthritis. Secondary fusion was required in 25% of cases with an average follow-up of 24 months.
  
  
  CONCLUSIONS
  The complication rate for talar fractures was high, mostly due to osteonecrosis and osteoarthritis; these conditions had an impact on the final outcome. The outcome could be improved by better evaluating these fractures with a CT scan, developing dual surgical approaches to best preserve the bone vascular supply and achieve better reduction, and improving the internal fixation hardware, especially the use of plates for comminuted fractures.
authors.affiliation: Service de chirurgie orthopédique, CHU Hôpital Sud, 16, boulevard de Bulgarie, 35200 Rennes cedex 2, France.
authors.forename: A
authors.initials: A
authors.lastname: Fournier
authors.forename: N
authors.initials: N
authors.lastname: Barba
authors.forename: V
authors.initials: V
authors.lastname: Steiger
authors.forename: A
authors.initials: A
authors.lastname: Lourdais
authors.forename: J-M
authors.initials: JM
authors.lastname: Frin
authors.forename: T
authors.initials: T
authors.lastname: Williams
authors.forename: V
authors.initials: V
authors.lastname: Falaise
authors.forename: V
authors.initials: V
authors.lastname: Pineau
authors.forename: E
authors.initials: E
authors.lastname: Salle de Chou
authors.forename: T
authors.initials: T
authors.lastname: Noailles
authors.forename: G
authors.initials: G
authors.lastname: Carvalhana
authors.forename: F
authors.initials: F
authors.lastname: Ruhlmann
authors.forename: D
authors.initials: D
authors.lastname: Huten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005602:France / Q000453:epidemiology; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome