OBJECTIVETo explore the application of the spiral computerized tomography (CT) image three-dimensional (3D) reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture.

METHODSUsing the multi-slice spiral CT image 3D reconstruction technique, we analysed 11 cases of talar neck fracture. The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws.

RESULTSIn the 11 cases, the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type II. And the remaining 5 cases of Hawkins types III and IV could not be classified exactly only by radiographs, one of whom was misdiagnosed. After using the CT image 3D reconstruction, the 5 cases were classified exactly before osteosynthesis. The classifications of these 11 cases were confirmed finally by surgical findings. The duration of operation were 45-140 min, averaging 81 min (including the duration of C-arm fluoroscopy). X-ray exposure time was 6-58 seconds, averaging 22 seconds. The blood loss was less than 100 ml. The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred. Postoperative follow-up was from 1 to 25 months. According to Hawkins score, excellent result was found in 6 type II cases and 1 type III case; good result in 1 type III case with both medial and lateral malleolar fracture, 1 type III with medial malleolus fractures and 1 open type III; fair result in 1 open type IV with lateral malleolus fracture.

CONCLUSIONSBy using the multi-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures, the accuracy of diagnosis can be improved obviously. Based on this technique, more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; diagnosis ; diagnostic imaging ; therapy ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Talus ; diagnostic imaging ; injuries ; Tomography, Spiral Computed

Adult ; Fractures, Bone ; surgery ; Humans ; Male ; Ossification, Heterotopic ; diagnostic imaging ; etiology ; Postoperative Complications ; diagnostic imaging ; etiology ; Talus ; injuries ; surgery ; Tomography, X-Ray Computed

BACKGROUND: The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures. METHODS: Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed. RESULTS: In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3). CONCLUSIONS: A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.
Adult ; Ankle Fractures/*diagnosis/diagnostic imaging ; Ankle Injuries/*diagnosis/diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Sports ; Talus/diagnostic imaging/*injuries ; Young Adult

OBJECTIVETo evaluate the clinical effects of surgical treatment for open dislocation of talus.

METHODSFrom June 2001 to July 2008,the complete data of 11 patients with open dislocations of talus were retrospectively analyzed, including 8 males and 3 females with an average age of 39.5 years (ranged 19 to 52). According to Gustilo typing, type I was in 2 cases, type II in 6 cases, type III A in 2 cases, type III B in 1 case. Five cases were tibial astragaloid joint dislocation in which 3 cases associated with subtalar joint dislocation, 4 cases were subtalar joint dislocation and 2 cases were total dislocation of talus. Among them, 8 dislocations associated with talus fractures. All patients were treated with debridement, open reduction, internal fixation with K-wires or screws and external fixation with plaster or external fixator within 8 hours after injury. External fixations were removed at 6 weeks after operation. Partial weight bearing was permitted only when X-rays indicated bony healing. Clinical effects were evaluated according to AOFAS system and X-ray films during follow-up.

RESULTSThe mean time of follow-up was 13.8 months(ranged 10 to 15 months). Eight patients with fractures obtained bone healing in 4-7 months with an average of 4.3 months. No infection of wound or deep tissue was found. At final follow-up, talus necrosis was in 2 cases and traumatic arthritis was in 2 cases. The AOFAS score was 71.3 +/- 8.6, among the total, the pain, function, alignment was respectively (32.4 +/- 7.1), (31.0 +/- 15.7), (7.6 +/- 2.3) scores.

CONCLUSIONComplete debridement may avoid infection in treating open dislocation of talus, early reduction and fixation is a key point during treatment.

Adult ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Talus ; injuries ; surgery ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the clinical effect of talar neck fractures treated by open reduction and internal fixation with screws.

METHODSAmong 28 cases in the study, 20 cases were males and 8 cases were female. The age ranged from 22 to 72 years with an average of 38 years. Based on the Hawkins classification,there were 6 cases of type I,18 of type I and 4 of type II. They were treated by open reduction and internal fixation with screws.

RESULTSTwenty-eight cases were followed up for 1 to 7 years(mean 2.8 years). The evaluation of the results by Hawkins functional rating scale revealed excellent in 14 cases,good in 9 cases, fair in 3 cases and poor in 2 cases. The excellent and good rate were 83.2%. Osteonecrosis occurred in 5 cases with 3 of type II and 2 of type III fractures. Two of 3 cases with talar displacement were found with osteonecrosis or painful arthritis. The subtalar arthritis occurred in 6 cases, 3 of which were associated with ankle arthritis. Two cases underwent arthrodesis because of painful arthritis of the subtalar joint or osteonecrosis of the talar body. Wound infection and anteromedial skin necrosis of the ankle were not found.

CONCLUSIONTreatment of talar neck fractures could obtain satisfactory clinical results through open reduction and internal fixation with screws. Protection of the residual blood supply, anatomically reduction and stable fixation are essential for successful treatment of talar neck fractures.

Adult ; Aged ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Talus ; injuries ; surgery

Absorbable Implants ; Adult ; Bone Screws ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Joint Dislocations ; diagnostic imaging ; physiopathology ; surgery ; Male ; Middle Aged ; Recovery of Function ; Talus ; injuries ; Tomography, X-Ray Computed