Charles A Mechas, Arun Aneja, Mark R Nazal, Richard W Pectol, Chandler R Sneed, Jeffrey A Foster, Daria L Kinchelow, Matthew W Kavolus, David C Landy, Arjun Srinath, Eric S Moghadamian
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引用次数: 1
Abstract
Background: The objective of this study was to determine whether talar neck fractures with proximal extension (TNPE) into the talar body are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck (TN) fractures.
Methods: A retrospective review of patients sustaining talar neck fractures at a level I trauma center from 2008 to 2016 was performed. Demographic and clinical data were collected from the electronic medical record. Fractures were characterized as TN or TNPE based on initial radiographs. TNPE was defined as a fracture that originates on the talar neck and extends proximal to a line subtended from the junction of the neck and the articular cartilage dorsal to the anterior portion of the lateral process of the talus. Fractures were classified according to the modified Hawkins classification for analysis. The primary outcome was the development of AVN. Secondary outcomes included nonunion and collapse. These were measured on postoperative radiographs.
Results: There were 137 fractures in 130 patients, with 80 (58%) fractures in the TN group and 57 (42%) in the TNPE group. Median follow-up was 10 months (interquartile range, 6-18 months). The TNPE group was more likely to develop AVN as compared to the TN group (49% vs 19%, P < .001). Similarly, the TNPE group had a higher rate of collapse (14% vs 4%, P = .03) and nonunion (26% vs 9%, P = .01). Even after adjusting for open fracture, Hawkins fracture type, smoking, and diabetes, AVN still remained significant for the TNPE group as compared to the TN group with an odds ratio of 3.47 (95% CI, 1.51-7.99).
Conclusion: We found a higher rate of AVN, subsequent collapse, and nonunion in patients with TNPE compared to isolated TN fractures.
Level of evidence: Level III, retrospective cohort study.
背景:本研究的目的是确定距颈近端延伸骨折(TNPE)与距颈孤立骨折(TN)相比，是否与更高的缺血性坏死(AVN)发生率相关。方法:回顾性分析2008年至2016年在某一级创伤中心收治的距颈骨折患者。从电子病历中收集人口统计和临床数据。根据初始x线片，骨折表现为TN或TNPE。TNPE被定义为发源于距骨颈并近端延伸至颈和关节软骨背侧连接处至距骨外侧突前部的一种骨折。按照改进的Hawkins分类对骨折进行分类分析。主要结果是AVN的发展。次要结局包括骨不连和塌陷。在术后x线片上测量。结果:130例患者发生骨折137例，其中TN组骨折80例(58%)，TNPE组骨折57例(42%)。中位随访时间为10个月(四分位数间距为6-18个月)。与TN组相比，TNPE组更容易发生AVN (49% vs 19%， P = 0.03)和骨不连(26% vs 9%， P = 0.01)。即使在调整开放性骨折、Hawkins骨折类型、吸烟和糖尿病等因素后，与TN组相比，TNPE组的AVN仍然显著，优势比为3.47 (95% CI, 1.51-7.99)。结论:我们发现，与孤立的TN骨折相比，TNPE患者的AVN、随后的塌陷和不愈合发生率更高。证据等级:III级，回顾性队列研究。
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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