title: Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures.
abstract: BACKGROUND
  Screws placed from posterior to anterior have been shown to be biomechanically and anatomically superior in the fixation of talar neck and neck-body fractures, yet most surgeons continue to place screws from an anterior start point. The safety and efficacy of percutaneously applied posterior screws has not been clinically defined, and functional outcomes after their use is lacking.
  
  
  METHODS
  After institutional review board approval, we performed a retrospective review of 24 consecutive talar neck fractures treated by a single surgeon that utilized posterior-to-anterior screw fixation. Clinical, radiographic, and functional outcomes were assessed at a minimum follow-up of 12 months. Functional outcomes including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Olerud-Molander Scores, and the Short Form 36 (SF-36) measurement were collected and reviewed. Average patient follow-up was 44 months.
  
  
  RESULTS
  According to the classification system of Canale and Kelly, there were 4 type I fractures, 15 type II fractures, 4 type III fractures, and 1 type IV fracture. Four patients had open fractures. One superficial wound infection occurred, 1 patient reported FHL stiffness, and 6 complained of numbness or paresthesias in the distribution of the sural nerve (5 transient, 1 permanent). One reoperation was required to exchange a screw impinging on the talonavicular joint. Radiographically, 44% developed a positive Hawkins sign, and the specificity of this finding was 100% for talar dome viability. Avascular necrosis developed in 43% of patients, with 33% revascularizing and none going on to collapse. Subtalar arthrosis developed in 62% of patients.
  
  
  CONCLUSIONS
  Screws placed from posterior to anterior are a useful technique in the treatment of talar neck fractures. Functional outcomes following their use appear favorable compared with recent reports with minimal risk to local structures.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, San Antonio, TX, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Mitchell
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA ccollinge@msn.com.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
mesh_terms: D000368:Aged; D001863:Bone Screws; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D008297:Male; D010020:Osteonecrosis / Q000209:etiology; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery
keywords: percutaneous; talar neck; talus