• Journal of Korean Foot and Ankle Society
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• v.1 no.2
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• pp.119-125
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• 1997

The fracture and fracture-dislocation of the neck of the talus (Hawkins' type I-IV) are uncommon injuries and represent only 0.12 to 0.32% of all fracures. Authors clinically evaluated in 12 cases Whom treated fracures of the neck of the talus, at department of orthopaedic surgery, Sun General Hospital, from 1990 to 1996, and the following results are obtained. 1. Of 12 cases, there were 11 males and 1 female, average age was 30 years. 2. Causes of fracture was fall down injury in 7 cases(58%), traffic accident in 4 cases(33%), direct trauma in 1 case(8%). 3. According to the classification by Hawkins' type I in 2 cases(17%), type II in 7cases (58%), type III in 3cases(25%). 4. Associated injuries were calcaneal fracture in 3 cases, fracture-dislocation of talus in 3 cases, subtalar dislocation in 3 cases, medial malleolar fracture in 5 cases, soft tissue injury in 3 cases, femur and tibia fracture in 1 case, and lumbar Spine compression fracture in 1 case. 5. Average time to operation after injury was 2.5 days. 6. In 2 cases were treated conservatively and 10 cases were treated open reduction and internal fixation with screw or K-wire. 7. Complications were avascular necrosis in 4 cases, post traumatic arthritis in 2 cases, skin necrosis in 4 cases, and then ankle fusion was done in 2 cases. 8. High rate of complication was seen in the talar neck fracture associated with calcaneal fracture. In the analysis of above results, evaluated by Hawkins' scoring system were excellent to fair in 75%.

• Journal of Yeungnam Medical Science
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• v.9 no.2
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• pp.302-311
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• 1992

Talus is a important structure of the ankle joint and its function is critical for ambulation and weight bearing. The talus fracture is rare, but the complications of fracture and dislocation are serious and resulting in avascular necrosis, osteoarthritis. So its treatment is carefully considered at initial status. Authors reviewed 11 cases of fracture and dislocation of the talus treated at Yeungnam university hospital from 1984 to 1991. The longest follow up was 8 years and shortest, 1 year. The results were as follows. 1. There were all males, the average age was 30 years old. 2. The most common cause was fall down(8 cases), and next traffic accident(2cases), sports injury(1 case). 3. According to Marti-Weber classification, 1 cases was type I, 1 in type II, 4 in type III and 5 in type IV. 4. The method of treatment were open reduction and internal fixation in 6 cases, the others were closed reduction in 5 cases. 5. Final results(by Hawkins grading system) were as follows, 3 cases were excellent, 4 cases were good, 1 case was fair and 3 cases were poor. 6. Complications were AVN in 2 cases, degenerative arthritis in 8 cases, malunion in 1 case. 7. The range of motion of the ankle joint was relatively preserved(74%), but in the subtalar joint it was decreased(43%).

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.91-96
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• 2007

Purpose: To evaluate the clinical results and determine appropriate methods of surgical treatment about type II talar neck fracture. Materials and Methods: Among nineteen patients who received surgical treatment for type II talar neck fracture from May 2000 to May 2005. Fourteen patients with a follow-up period of more than 1 year were divided into two groups. Six patients reduced by closed reduction (Group A) with screw fixation and eight patients reduced by open reduction with screw fixation. We analyzed preoperative, postoperative and follow-up simple radiographs and reviewed patient hospital records retrospectively. Clinical results were evaluated by Hawkins scoring system. We analyzed pain, limp, range of motion of ankle and subtalar joint. Results: Five patients (83.3%) in group A and seven patients (87.7%) in group B had excellent and good clinical results. There were no complications including avascular necrosis, delayed union, nonunion. Conclusion: Closed reduction with screw fixation of talar neck fracture shows correct reduction and satisfactory results. But because of short term period of follow-up, we need long term results.

• Journal of Korean Foot and Ankle Society
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• v.17 no.2
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• pp.106-114
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• 2013

Purpose: Posteroanterior screw fixation is biomechanically stronger than anteroposterior screw fixation. However, there are few literature about the correlation between clinical results and more strength by posteroanterior fixation. This study was performed to evaluate the clinical outcomes of the accelerated rehabilitation following anterior open reduction and posterior percutaneous screw fixation for displaced talar neck fractures. Materials and Methods: Eighteen cases were followed up for more than 1 year after posteroanterior fixation using headless compression screw for talar neck fractures. The clinical evaluation was performed according to American Orthopaedic Foot and Ankle Society (AOFAS) score and Hawkins criteria. As radiographic evaluation, the degree of fracture displacement, period to union, and occurrence rate of complications such as avascular necrosis through MRI were measured. Results: The AOFAS score was average 90.4 points at the last follow-up. There were 7 excellent, 9 good, and 2 fair results according to the Hawkins criteria. Therefore, 16 cases(88.8%) achieved satisfactory results. The degree of fracture displacement had improved significantly from preoperative average 5.6 mm to 1.2 mm immediate postoperatively, and maintained to 1.1mm at the last follow-up. All cases achieved bone union, and the period to union was average 12.4 weeks. There were 3 cases of avascular necrosis of talar body and 2 cases of post-traumatic arthritis. Conclusion: Anterior open reduction and posterior percutaneous headless screw fixation seems to be an effective surgical method for displaced talar neck fractures, because of the possibility of accurate restoration of articular surface, fixation strength enough to early rehabilitation, and needlessness of hardware removal.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.171-175
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• 2015

Purpose: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. Materials and Methods: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (${\geq}5^{\circ}$), negative value of 5th metatarsal-tibial angle. Conclusion: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.

• Journal of Korean Foot and Ankle Society
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• v.5 no.1
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• pp.28-34
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• 2001

Study design: Clinical results were retrospectively analyzed in 11 patients with fractures of talar neck who were treated in our department from Jan. 1994 to Dec. 1999. Objective: The purpose of this study is to evaluate the short-term results and to assess the prognostic factors of talar neck fractures. Material and Method: 11 cases with fractures of talar neck were reviewed retrospectively with minimum 1 year follow-up. There were 8 men & 3 women, and the average age was 25. The most common cause was traffic accident. According to the modified Hawkins classification, type I was in 4 cases, type II in 5, type III in 2, and type IV was none. All type I fractures were treated conservatively, and others were treated operatively. Results: According to Hawkins criteria, there was excellent result in 7 cases(64%), good in 2(18%), and fair in 2(18%). Post-traumatic arthritis occurred in 2 cases, but there was no avascular necrosis. Conclusion: Careful selection of method of treatment and urgent management are important prognostic factors in talar neck fractures. The longer follow-up in more cases is necessary to evaluate the long-term clinical results and complications more accurately.

• Journal of Korean Foot and Ankle Society
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• v.14 no.1
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• pp.79-83
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• 2010

Purpose: To compare the clinical and radiological results between the anterior and posterior screw fixation for the treatment of talar neck fracture. Materials and Methods: Among 30 patients who received surgical treatment for talar neck fracture from 2001 to 2008. Twenty-seven patients with a follow-up period of more than 1 year were divided into two groups. Twelve patients were treated with anterior screw fixation and 15 patients with posterior approaches. We analyzed preoperative, postoperative and follow-up radiographs. Clinical results were evaluated by Hawkins criteria. Results: The posteriorly inserted screws were placed across the more central portion of the talar neck and perpendicular to the plane of fracture (p<0.05). There were no difference in clinical results, the duration of union, and complications including avascular necrosis between two groups. However, 2 patients complained of pain around the talonavicular joint in the anterior insertion group. Conclusion: Although the clinical results were good irrespective of insertion methods, the posterior approach of screw fixation for talar neck fractures allows for a better mechanical advantage than anterioly placed screws. This may allow early motion with a reduced risk of failure of fixation or of displacement of the fracture.

• Journal of Korean Foot and Ankle Society
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• v.18 no.2
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• pp.76-79
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• 2014

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.