28 cases of complex high energy talus fractures, corresponding to class III and class IV according to Marti Weber classification, were evaluated. The following variables were considered: type of trauma, type of surgery, type of reduction and type of osteosyntesis. As complications, rupture of the tendon of the flexor longus allux, sural nerve lesion and deltoideus ligament lesion were occasionally reported. Pull or compression lesion of the posterior vasal-nerve bunldle was observed in 10% of cases. Early skin complications, like suffering of the surgical wound and infections, were frequent. Malunion prevalence seems to be relatively high and significantly correlatable with type of osteosyntesis. Malunion was observed once among 15 cases treated with osteosyntesis in compression, while 6 on 13 cases among patients operated with Kirschner wires or external fixation. No significant correlation was found between the type of osteosyntesis and osteonecrosis, which seems to be influenced not only by the lesion entity but also by time elapsing between trauma and reduction: necrosis was observed in 4 among 17 cases operated within 12 hours and in 5 among 11 cases treated beyond 12 hours. Non-correspondence between appearance of osteonecrosis and need of subsequent surgical repair has to be underlined: only 2 out of 9 cases of osteonecrosis needed a talar arthrodesis.
Complex Talus fractures; variables influencing clinical evolution
MASSE', Alessandro
2006-01-01
Abstract
28 cases of complex high energy talus fractures, corresponding to class III and class IV according to Marti Weber classification, were evaluated. The following variables were considered: type of trauma, type of surgery, type of reduction and type of osteosyntesis. As complications, rupture of the tendon of the flexor longus allux, sural nerve lesion and deltoideus ligament lesion were occasionally reported. Pull or compression lesion of the posterior vasal-nerve bunldle was observed in 10% of cases. Early skin complications, like suffering of the surgical wound and infections, were frequent. Malunion prevalence seems to be relatively high and significantly correlatable with type of osteosyntesis. Malunion was observed once among 15 cases treated with osteosyntesis in compression, while 6 on 13 cases among patients operated with Kirschner wires or external fixation. No significant correlation was found between the type of osteosyntesis and osteonecrosis, which seems to be influenced not only by the lesion entity but also by time elapsing between trauma and reduction: necrosis was observed in 4 among 17 cases operated within 12 hours and in 5 among 11 cases treated beyond 12 hours. Non-correspondence between appearance of osteonecrosis and need of subsequent surgical repair has to be underlined: only 2 out of 9 cases of osteonecrosis needed a talar arthrodesis.
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