Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures
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 poste...
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| Veröffentlicht in: | Foot & ankle international 2016-10, Vol.37 (10), p.1130-1136 |
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| creator | Beltran, Michael J. Mitchell, Phillip M. Collinge, Cory A. |
| description | 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.
Conclusion:
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.
Level of Evidence:
Level IV, retrospective case series. |
| doi_str_mv | 10.1177/1071100716655434 |
| format | Article |
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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.
Conclusion:
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.
Level of Evidence:
Level IV, retrospective case series.</description><identifier>ISSN: 1071-1007</identifier><identifier>EISSN: 1944-7876</identifier><identifier>DOI: 10.1177/1071100716655434</identifier><identifier>PMID: 27340258</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Bone Screws ; Follow-Up Studies ; Fracture Fixation, Internal - adverse effects ; Fracture Fixation, Internal - methods ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - surgery ; Fractures, Open - surgery ; Humans ; Male ; Osteonecrosis - etiology ; Pain Measurement ; Postoperative Complications - etiology ; Radiography ; Reoperation ; Retrospective Studies ; Talus - diagnostic imaging ; Talus - injuries ; Talus - surgery</subject><ispartof>Foot & ankle international, 2016-10, Vol.37 (10), p.1130-1136</ispartof><rights>The Author(s) 2016</rights><rights>The Author(s) 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-62389d4ccbf3c8f4c102d8d69d623ffacb395694f21ea86753499f71d216d5413</citedby><cites>FETCH-LOGICAL-c403t-62389d4ccbf3c8f4c102d8d69d623ffacb395694f21ea86753499f71d216d5413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1071100716655434$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1071100716655434$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27340258$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beltran, Michael J.</creatorcontrib><creatorcontrib>Mitchell, Phillip M.</creatorcontrib><creatorcontrib>Collinge, Cory A.</creatorcontrib><title>Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures</title><title>Foot & ankle international</title><addtitle>Foot Ankle Int</addtitle><description>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.
Conclusion:
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.
Level of Evidence:
Level IV, retrospective case series.</description><subject>Aged</subject><subject>Bone Screws</subject><subject>Follow-Up Studies</subject><subject>Fracture Fixation, Internal - adverse effects</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - surgery</subject><subject>Fractures, Open - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Osteonecrosis - etiology</subject><subject>Pain Measurement</subject><subject>Postoperative Complications - etiology</subject><subject>Radiography</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Talus - diagnostic imaging</subject><subject>Talus - injuries</subject><subject>Talus - surgery</subject><issn>1071-1007</issn><issn>1944-7876</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEtLAzEUhYMotlb3riRLN6PJJJPHslSrQq2CdT2kecjUmUlNZpD-e1NGXQhu7r1wvnPgHgDOMbrCmPNrjDjGKA3GioISegDGWFKaccHZYbqTku31ETiJcYMQ5gTLYzDKOaEoL8QYLJ997GyofICdh9N2uOsdvKmC1Z018EUH-xmhS8SjatWbbWzbQe_gStUqwKXV73AelO76YOMpOHKqjvbse0_A6_x2NbvPFk93D7PpItMUkS5jORHSUK3XjmjhqMYoN8IwaZLinNJrIgsmqcuxVYLxglApHccmx8wUFJMJuBxyt8F_9DZ2ZVNFbetatdb3scQiZxxRIfYoGlAdfIzBunIbqkaFXYlRuW-x_Ntislx8p_frxppfw09tCcgGIKY-yo3vQ5u-_T_wCy59eHc</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Beltran, Michael J.</creator><creator>Mitchell, Phillip M.</creator><creator>Collinge, Cory A.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161001</creationdate><title>Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures</title><author>Beltran, Michael J. ; Mitchell, Phillip M. ; Collinge, Cory A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-62389d4ccbf3c8f4c102d8d69d623ffacb395694f21ea86753499f71d216d5413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Bone Screws</topic><topic>Follow-Up Studies</topic><topic>Fracture Fixation, Internal - adverse effects</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - surgery</topic><topic>Fractures, Open - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Osteonecrosis - etiology</topic><topic>Pain Measurement</topic><topic>Postoperative Complications - etiology</topic><topic>Radiography</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Talus - diagnostic imaging</topic><topic>Talus - injuries</topic><topic>Talus - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beltran, Michael J.</creatorcontrib><creatorcontrib>Mitchell, Phillip M.</creatorcontrib><creatorcontrib>Collinge, Cory A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Foot & ankle international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beltran, Michael J.</au><au>Mitchell, Phillip M.</au><au>Collinge, Cory A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures</atitle><jtitle>Foot & ankle international</jtitle><addtitle>Foot Ankle Int</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>37</volume><issue>10</issue><spage>1130</spage><epage>1136</epage><pages>1130-1136</pages><issn>1071-1007</issn><eissn>1944-7876</eissn><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.
Conclusion:
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.
Level of Evidence:
Level IV, retrospective case series.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>27340258</pmid><doi>10.1177/1071100716655434</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
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| source | MEDLINE; SAGE Journals |
| subjects | Aged Bone Screws Follow-Up Studies Fracture Fixation, Internal - adverse effects Fracture Fixation, Internal - methods Fractures, Bone - diagnostic imaging Fractures, Bone - surgery Fractures, Open - surgery Humans Male Osteonecrosis - etiology Pain Measurement Postoperative Complications - etiology Radiography Reoperation Retrospective Studies Talus - diagnostic imaging Talus - injuries Talus - surgery |
| title | Posterior to Anteriorly Directed Screws for Management of Talar Neck Fractures |
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