Journal of Musculoskeletal Trauma

Current Management of Talar Fractures: Gun-Woo Lee, Keun-Bae Lee; J Korean Fract Soc 2022;35(1):31-37. Published online January 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.1.31

Abstract PDF: Talar fracture management is one of the most challenging tasks for orthopedic surgeons. High complication rates and functional impairments after talar fractures have been well documented, and thus, surgical strategies capable of perfect anatomic reduction and stable fixation are important. The current review was undertaken to provide recommendations regarding updated surgical strategies that include surgical timing, approach, fixation methods, and the prevention and treatment of possible complications.

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Fracture of the Talus: Tae Jung Bang, Sun Kyu Kim, Hyung Jin Chung; J Korean Fract Soc 2016;29(3):213-220. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.213

Abstract PDF: Although talus fractures are uncommon, proper management is important because they are often associated with severe complications. Talar neck and body fractures occupy most of the talar fractures. It remains controversial whether talar neck fractures require emergent or elective treatment. Elective definitive fixation, however, may reduce risks of wound complications. Many surgeons recommend dual surgical approachesâ€”anteromedial and anterolateralâ€”to allow accurate visualization and anatomic reduction. Although there are various methods of fixation, the use of plates is necessary in comminuted talar fractures. Outcomes may vary and will be dependent on the degree of the initial fracture displacement. It is necessary to restore articular congruency and axial alignment for normalizing hindfoot function. Common complications include posttraumatic arthritis, avascular necrosis, malunion, and nonunion.

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Peroneus Tendon Dislocation Associated with Fracture of Lateral Process of Talus: A Case Report: Youn Soo Hwang, Sung Jun Jo, Kwang Yeol Kim, Hyung Chun Kim, Dong Seon Kim; J Korean Fract Soc 2014;27(3):222-226. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.222

Abstract PDF: Traumatic peroneal tendon dislocation in association with fracture of the lateral process of the talus is a rare injury, which is difficult to diagnose. As a result, early detection is often delayed, which in turn leads to ankle pain and dysfunction. We treated a patient by open reduction and screw fixation in fracture of the lateral process of talus and primary repair of the superior peroneal retinaculum. We report this case with a brief review of the literature.

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Surgical Treatment for Fractures of the Talus: Ho Rim Choi, Jang Geun Lee, Hun Hwi Choi, Sung Woo Choi; J Korean Soc Fract 2003;16(1):67-73. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.67

Abstract PDF: PURPOSE
To evaluate the clinical results and develope guidelines for surgical treatment of talus fracture.
MATERIALS AND METHODS
Among the 60 cases that were treated during March 1990 to November 2000, 34 cases were treated operatively and followed up for more than one year( range: 1 4.4 years ). They were analyzed retrospectively with questionnaire directly or by telephone interview, radiograms and medical records. Clinical results were evaluated by Hawkins 'scoring system.
RESULTS
25 out of 34 cases showed satisfactory results. Unisatisfactory results were seen in cases that we couldn 't achieve anatomical reduction due to severe communition, and also in case of delayed treatment due to associated trauma and soft tissue injury. Six out of 8 cases that showed no Hawkins 'sign developed avascular necrosis. However, satisfactory results were achieved through conservative treatment.
CONCLUSION
Satisfactory results could be achieved through early anatomical reduction and rigid internal fixation followed by aggressive rehabilitation. There was no differences in clinical results either by the surgical approach or method of internal fixation. Avascular necrosis was not essentially related to the clinical results.

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Peritalar Dislocations or Fracture-Dislocations: Seung Koo Rhee, Hwa Sung Lee, Jong Bum Park, Jin Wha Chung, Eui Yong Um, Whi Ju Whang; J Korean Soc Fract 2001;14(4):689-697. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.689

Abstract PDF: PURPOSE
To find the proper way and timing of treatment for minimizing the posttraumatic complication of peritalar dislocation or fracture-dislocation.
MATERIALS AND METHODS
We reviewed total 12 cases of peritalar dislocation or fracture-dislocation that consist of 9 cases of subtalar joint dislocations, I case of talonavicular joint dislocation and 2 cases of talar fracture-dislocations. Closed reduction was performed for subtalar dislocation without suturing the torn ligaments. The average follow up period was 25 months.
RESULTS
Of 9 subtalar dislocations, 8 cases presented acceptable results. But 1 case of a 28-year-old male patient with prolonged heavy sports activity history presented pain and mild limping. The other 3 cases of talo-navicular joint dislocation and talar fracture-dislocations presented acceptable results except one complaining of scar contracture.
CONCLUSION
Complications such as early skin necrosis or neurovascular damage could be prevented by early closed reduction for peritalar dislocations or fracture dislocations, and the repair of torn ligaments of ankle joint in peritalar dislocations did not affect the end results.

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Analysis and Clinical Study on Fracture Dislocation of the Talus: Ye Yeon Won, Chang Hoon Jeon, Jae In Ahn, Seung Jun Choi, Jung Mo Lee; J Korean Soc Fract 2000;13(2):382-389. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.382

Abstract PDF: PURPOSE
: Talar fractures are uncommon and so surgeon's experience in the treatment of the talar fracture is limited. This study was undertaken to evaluate the incidence, associated injuries, complications of talar fracture and results of treatment.
MATERIALS AND METHODS
: Authors experienced 15 cases of the talar fractures treated at Ajou university Hospital from 1995 to 1998 with minimal 1 year follow-up period and obtained following result.
RESULTS
: Of 15 cases, fall down injury was the most common cause of injury(11/15). 4 ipsilateral medial malleolar fractures, 2 lateral malleolar fractures and other associated injury was occured. According to the Hawkins' classification 5 cases in type I , 1 cases in typeII, 2 cases in typeIII were observed. 2 posttraumatic arthritis, 1 skin necrosis, 1 avascular necrosis, were observed as complications but nonunion was not observed.
CONCLUSIONS
: We suggest that early and accurate anatomical reduction and rigid internal fixation of the fracture dislocation of the talus canprevent complications such as acascular necrosis, posttraumatic arthritis.

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Posttraumatic avascular necrosis of talus: Soo Bong Hahn, Hong Jun Park, Kee Hong Song; J Korean Soc Fract 2000;13(2):368-374. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.368

Abstract PDF: PURPOSE
: We performed this study in order to analyze the clinical results and complications of posttraumatic avascular necrosis of talus MATERIALS AND METHODS : We performed a retrospective review of 19 patients undertaken treatment of talus fracture from September 1996 to September 1998. There were 11 males and 8 females with an a mean age of 21.4 years(range, 10-52years).
RESULTS
: In one case, there was soft tissue defect and bone maceration on dorsum of left foot due to crushing injury by traffic accident. The patient was treated with debridement and skin graft. In trauma 5 months, equinus deformity and stiffness of ankle was noted. Posttraumatic avascular necrosis of talus was noted at magnetic resonance imaging. But, there was neither collapse of talar dome nor pain. Therefore, heel cord lengthening and correction of equinus by hinged Ilizarov with distraction was done. In follow-up(1 year 3 months), avascular necrosis was improved and good ambulation without pain was possible. In another case, open reduction and internal fixation for talar neck fracture(Hawkins typeIII)was performed. In trauma 9 months, there were severe degenerative arthritis of peritalar joint, severe ankle pain, and severe avascular necrosis with collapse of talus. Therefore, dead bone resection and ankle arthrodesis with autoiliac bone graft were performed using Ilizarov external fixator. In follow-up(trauma day 1 year 11 months), good ambulation in 90degreesankle fusion state without pain was possible.
CONCLUSION
: In the treatment of talus fracture, periodic physical and radiologic examination is important for early detection of posttraumatic avascular necrosis and early management.

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Treatment of fracture-dislocation of talar neck or body: Byoung Ho Lee, Sang Ho Ha, Min Hyuk Choi; J Korean Soc Fract 1999;12(2):307-313. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.307

Abstract PDF: From January 1992 to December 1996, authors analyzed 26 cases of fracture-dislocation of talar neck or body, treated at Chosun University Hospital retrospectively. There were 20 males and 6 females and the average age was 34 years old. The follow up period was at least 14 months. There were 19 neck fracture-dislocations, 6 body fractures and total dislocation of talus. Three type I talar neck fractures were treated conservertively. In six cases, in which either three cases of severe open type III talar neck fracture or three cases of severly comminuted talar body fracture, primary fusion was performed. Other seventeen cases of fracture-dislocation were treated by open reduction and internal fixation. Excellent results were observed in 6 cases, good in 7 cases, fair in 11 cases and poor in 2 cases. The result of primary arthrodesis for severe injury of talus was relatively good. Complications were avascular necrosis in 7 cases, posttraumatic arthritis in 5 cases, skinnecrosis in 3 cases, wound infection in 2 cases and malunion in 2 cases.

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Sbuchondral Curettage & Bone Peg Fixation in Osteochondral Fracture of The Talus: Myung Chul Yoo, Yoon Je Cho, Hyun Sub Kwon, Jae Young Park; J Korean Soc Fract 1998;11(4):932-940. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.932

Abstract PDF: Osteochondral fracture is an attached fragment of subchondral bone become partially or completely separated from the underlying bone. Accurate diagnosis of osteochondral fracture of the talus,mainly caused by trauma, is difficult because osteochondral lesion is not detected easily on the roentgenographic examination. Osteochondal fracture is intraarticular fracture, thus operative approach and fixation is technically difficult and requires talus, with subchondral bone curettage through percutaneous extraarticular transtalar approact under the C-arm guide without arthrotomy in three cases of minimally detached or elevated osteochondral fragment. And two cases of partially detached osteochondral fragment treated by bone peg fixation with arthrotomy. We obtained good functional results at the follow-up of a mean of 1 year and 5 months. We believe that the subchondral curettage and bone peg fixation are excellent treatment methods for osteochondral fracture of the talus.

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Surgical Treatment for Displaced Talus Fracture-Dislocation: Kwang Soon Song, Chul Hyung Kang, Seong Ryeol Kim; J Korean Soc Fract 1998;11(4):906-911. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.906

Abstract PDF: Talus fracture is an uncommon fracture and frequently accompanied with serious complications such as avascular necrosis, nonunion and osteoarthritis. The purpose of this paper is to assess the effectiveness of open reduction and internal fixation in treatment of displaced talus fracture. Fourteen patients with severely displaced talus fracture-dislocation, classified as more severe than Hawkins type III and comminuted body fracture were evaluated. They were treated at Keimyung University Dongsan Medical Center during the period of July 1989 to August 1996. The average period for follow up was 53 months, ranging from 18 months to 8 years. All patients were treated by open reduction and internal fixation using screws except 2 cases of severe talar body fractures, which were treated by Blair fusion. according to Hawkins scoring system. the end results were excellent only in 4 cases, good in 2, fair in 5, poor in 3. Avascular necrosis developed in 3 cases and traumatic arthritis in 5 cases. In conclusion, displaced talus fracture-dislocation had a high incidence of postoperative complications(57%) in spite of early sugical treatment. It is essential to consider about possible complications and sequelae before operation is performed.

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Fracture - Dislocation of the Talus: Jeung Tak Suh, Yong Ho Suh, Chong Il Yoo; J Korean Soc Fract 1997;10(3):470-479. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.470

Abstract PDF: The talus is one of the most important bones of the foot because it supports and distributes body weight above it and allows motion between the tibia and the foot. And it has unique biomechanical feature and vascular supply. Fractures and dislocations of talus are uncommon. However, once those happen, there is no single method of treatment and, all the more, there are several severe complications and are subsequent disabililies. Authors analyzed 15 cases of fracture-dislocation of the talus, which had been treated at Pusan National University Hospital from May 1988 to December 1994. 1. Among the 15 cases, there were 13 male and 2 female and the average age was 28.4 ranged from 6 to 48. 2. The causes were traffic accidents in 11, failing down in 4 cases. A violent hyperdorsiflexion of the ankle was common mechanism of the fracture. 3. According to the classification by Hawkins, there were 9 cases in talar neck fracture(2 cases in type I, 3 in type II, 4 in type III), 1 was head fracture and 5 were body fractures. 4. Two cases of talar neck fracture type I were treated conservatively, and other types were treated operatively. 5. Final results, evaluated by the criteria of Hawkins, were as follows : excellent in 3 cases, good in 7, fair in 4 and poor in one. 6. Complications were avascular necrosis in 4 cases and traumatic arthritis in 3 cases. According to the results, talar neck fracture associated with marked displacement, comminution of subtalar joint and dislocation increased the rate of occurrence of complications despite of early open reduction and internal fixation.

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A treatment for the Fracture-Dislocation of the Talus: Sung Kwan Hwang, Kwang Jong Yoo; J Korean Soc Fract 1996;9(4):1016-1025. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1016

Abstract PDF: Fractures of the talus are uncommon injuries. Because of the unique blood supply and biomechanical features. the complication of the displaced fractures are frequent and long term disabilities are so severe that the importance of proper treatment is emphasized. A clinicaT evaluation of 25 patients with fracture of the talus has been made from January, 1985 to December, 1994 and followed them more than 12 months for each. The result were as follows; 1. There are 20 men and 5 women and the average age was 31.2 years. 2. The common causes of fracture were traffic accidents in 13 cases(52%) and fall from height in 9 cases(32%). 3. According to the classification by Hawkins, four of the fractures were included in type I, eight in type II, six in type III, one in type IV and six in body and process. 4. All 4 cases in type I. 1 case in type II and 4 cases in body and process fractures were treated conservatively, 7 cases in type II, 6 cases in type III, 1 case in type IV and 2 cases in body and process fractures were treated operatively. 5. According to the Hawkins criteria, final result were as follows; excellent in 10 cases, good in 7 cases, fair in 5 cases, poor in 3 cases. 6. Among the operatively treated type II, III, IV, delayed operations wrre performed in type II(2 cases). type III(3 cases). The final results of the delayed operations were good in one case, fair in one cases, poor in three cases. In conclusion, the results of the delayed operation were worse than those of the early operation, so we think that the early operation of talar fracture and dislocation will give good results.

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A Treatment for Fracture of the Talar Neck: Kun Yung Lee, Young Kee Lee, Yong Mann Cho, Cheon Dong Lee; J Korean Soc Fract 1996;9(4):1009-1015. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.1009

Abstract PDF: The talus has some important anatomic features. Approximately 60% of its surface is cartilage and the talus often has problems with circulation. Talar neck fracture have a high association with osteonecosis and osteoarthritis. Authors have analysed 16 cases of the talar neck fractures treated at Lee-Rha General Hospital from January 1990 to December 1995 with minimal 1 year follow up. The results were as follows; 1. In the 16 cases, there were 14 males and 2 females, the age between 20 and 40 years old was 10 cases(63%). 2. The most common rause of injury was traffic accident(63%), with sudden hyperextension as its mechanism. 3. Associated injuries were 4 malleolar fracutres, 3 calcaneous fractures, 3 spine fractures, 3 tibiofibular fractures and 2 femur fractures. 4. According to the Hawkins classification ; 3 cases in type 1, 4 cases in type II, 5 cases in typeIII, 4 case in type IV fractures were observed. 5. The method of treatment, all 3 cases of Hawkins type I fractures were treated by closed reduction and cast immobilization, 3 cases of Hawkins type II and 1 case of Hawtins type III fracture were treated by closed reduction and internal fixation, other 9 cases were treated by open reduction and internal fixation. 6. Excellent results were observed in 8 cases, good in 5 cases, fair in 2 cases, poor in 1 case with the Hawkinstherapeutic criteria. 7. Complications were observed 3 avascular necrosis, 2 post-traumatic arthritis, 2 ankle stiffness and 1 skin necrosis. From the above results, authors believe that early anatomical reduction & internal fixation is importent to get a satisfactory result in the treatment of tatar neck fracture.

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The Surgical Treatment and Prognosis of the Talar Body Fracture: Hyung Yeoun Choi, Jae Hyung Lee, Il Ho Kim; J Korean Soc Fract 1995;8(4):864-869. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.864

Abstract PDF: Fracture of the talus is infrequent injury when they occur, gut, the complications of the displaced fractures are frequent and resulting disabilities are severe that the importance of proper management is emphasized. Authors reviewed 18 cases of talus fracture (Hawkins classification type III and IV) treated at Department of orthopaedic surgery, Capital Armed force Gerneral Hospital from 1991 to 1994 to evaluate the result. The results were as follows; 1. Most common cause was fall down. 2. Associated injuries were fracture of the medial malleolus, calcaneus and Bursting fracture of spine. 3. The methods of treatment were open reduction and screw fixation in all cases. 4. Classification by Hawkins were Type III in 12 cases and Type IV in 6 cases. 5. Final clinical result by Hawkins criteria were good in 6 cases, fair in 7 cases and poor in 5 cases. 6. Complications were avascular necrosis in 7 cases, degenerative arthritis in 5 and nonunion in 3.

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A Clinical Study of Fracture of Neck of the Talus: 6 Cases Report: Kyung Ckul Kim, Sung Joon Im, Bo Seok Kong, Bo Hyeong Bang; J Korean Soc Fract 1992;5(2):365-371. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.365

Abstract PDF: The talus is a important bone because it supports and distributes the body forces above it. The fractures of the talus are not common but the talus is a bone with unique biomechanical features and vascular supply, so the complications with avascular necrosis and tramatic arthritis are frequent and resulting disabilities are so severe that the importance of proper management is emphasized. We analyzed 6 cases of fracture-dislocation of the talus, treated at Koryo General Hospital from 1987 to 1991. The follow up period was at least 12 months. The results were as follows ; 1. Of 6 cases, all were males and almost were 3rd and 4th decade. 2. The causes were traffic accident and fall from height. 3. Associated injuries were fracture of medial malleolus, tibia and Os calcis. 4. According to modified Hawkons classification, type I was 1 case, type II and type III were 2cases and type IV was 1 case. 5. 1 case in type II was treated conservatively, and 5 cases in other types were treated operatively. 6. Complications were skin infection and necrosis in 3 cases, failure of reduction in 2 cases, avascular necrosis in 3 cases and degenerative arthritis in 2 cases. 7. Complications wlth avascular necrosis and degenerative arthritis were treated with fusion of ankle and subtalar joint with external fixator.

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Total Dislocation of talus: A Case Report: Chang Uk Choi, Soo Kyun Rah, Byung Il Iee, Yoo Seong Seo, Jong Seok Park; J Korean Soc Fract 1990;3(2):259-261. Published online November 30, 1990; DOI: https://doi.org/10.12671/jksf.1990.3.2.259

Abstract PDF: Total dislocation of talus is a rare injury which induce high complication rate. The mechanism of this dislocation results from excessive inversion and eversion. The authors experienced one case of open total dislocation of talus and treated by open reduction and followed by subsequent total talectomy due to infection. So We report this case with review of literature.

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Clinical Observation for the Treatment of Talus Fracture: Yung Khee Chung, Baek Yong Song, Yong Whan Woo; J Korean Soc Fract 1989;2(2):189-193. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.189

Abstract PDF: Major fractures and dislocations of the talus are uncommon, but the management of this fracture and of the complications is difficult. The results of treatment of this fracture as a whole are generally poor. This is mostly due to frequent complications such as avascular necrosis of the talus. The authors analyzed the 13 cases of the talus fracture and evaluated the results. We obtained the following results; 1. In final results, 3 cases were excellent, 4, cases were good, 3 cases were fair and 2 cases were poor. 2. Avascular necorsis of the talar body occurred in 4 cases of all fractures. 3. Other complications were arthrofibrosis, subtalar arthritis, infection and drsal exostosis of the talar neck.

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Fracture of the Neck of the Talus: Ik Dong Kim, Poong Taek Kim, Byung Chul Park, Young Wook Choi, Young Gu Lyu, Sung Ho Kim; J Korean Soc Fract 1989;2(2):179-188. Published online November 30, 1989; DOI: https://doi.org/10.12671/jksf.1989.2.2.179

Abstract PDF: We Clinically analysed 10 cases of fractures of the neck of the talus which had been treated at the Department of Orthopedic Surgery, Kyungbook Nantional University Hospital from 1984 to 1988 and the following results were obtained. 1. Of the 10 cases, Hawkiins type I was 2 cases, type II, 4 cases and type III, 4 cases. 2. Avascular necrosis was developed in 7 cases. 1 of type I, 3 of type II and 3 of type III. 3. In all 6 cases with comminution at subtalar and medial aspect of talus, avascular necrosis was developed. 4. Hawkins sign was evident in the plane roentgenogram from 5th weeks to 12th weeks(mean at 8th weeks) and we could diagnose the avascular necrosis of talar body at 9.3th weeks. 5. Bone scan was not a helpful diagnostic tool for the confirmation of the avascular necrosis of the talar body. 6. Absolute non-weight bearing is mandatory until solid union is obtained and partial weight bearing with PTB brace is advisable after emergence of the sign of revasculariztion on the plane roetgenogram. 7. Of the 10 cases of the fracture of the neck of the talus, satisfactory results were obtained in 7 cases and of the 7 cases with avascular necrosis, relatively good results were in 5 cases.

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