A retrospective analysis of the definitive management of open talus fractures at a major trauma centre, comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines

Purpose Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion. Methods A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient’s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM. Results Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. Conclusion FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

Open Reduction and Internal Fixation of a Pediatric Talar Body Fracture using a Medial Malleolar Osteotomy – A Case Report

Introduction:Talus fracture injuries are rare and most literature pertains to fractures in skeletally mature adults. It is unusual for pediatric talus fractures to be treated operatively and is normally treated with immobilization. The location of the talus fracture required a medial malleolar osteotomy to facilitate exposure and reduction, which was fixed with temporary smooth K-wires. The authors were unable to identify a previous description of this technique in the literature. Case Report:An 11-year-old female was referred to our hospital due to polytraumatic injuries sustained in a roll-over MVC. A displaced fracture of the talus body was present. Due to the fracture location, a medial malleolar osteotomy was required for exposure. An open reduction and internal fixation was performed using subchondral minifragment screws under general anesthesia. The patient healed uneventfully, regained a normal gait and full, pain-free range of motion. Conclusions:Medial malleolar osteotomy with smooth K-wire fixation appears to be a safe method for gaining access to the talus when required for reduction and/or fixation of pediatric talus fractures. Keywords:Adolescent, talus fracture, osteotomy.

Outcome of neglected talus neck fracture and it’s management: A Case Report

Introduction: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6–8). A high level of clinical suspicion is required to avoid missing such injuries. Case Report: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. Conclusion: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity. Keywords: Talar neck fracture, non-union talus fracture, delayed union talus.