Tibial Nerve Dysfunction Associated With Operatively Treated Talar Neck Fractures.

Area of Science:

• Orthopedic Surgery
• Neurology
• Trauma Care

Background:

• Talar neck fractures are complex injuries requiring surgical intervention.
• Potential neurological complications, such as tibial nerve dysfunction (TND), can impact patient outcomes.
• Understanding the incidence and risk factors for TND is crucial for effective management.

Purpose of the Study:

• To determine the prevalence of tibial nerve dysfunction (TND) in patients who underwent surgical treatment for talar neck fractures.
• To identify factors associated with an increased risk of TND in this patient population.

Main Methods:

• A retrospective chart review was conducted at a Level-1 trauma center.
• The study included 65 talar neck fractures treated with open reduction and internal fixation between 2014 and 2018.
• Data on TND incidence, fracture characteristics (Hawkins grade, open vs. closed), and associated dislocations were analyzed.

Main Results:

• Tibial nerve dysfunction (TND) was identified in 30.8% (20 of 65) of operatively treated talar neck fractures.
• The incidence of TND increased with higher Hawkins fracture grades (Hawkins II: 21.9%, III: 41.7%, IV: 60%) and was significantly higher in open fractures (57.9%).
• TND was associated with tibiotalar dislocation but not subtalar dislocation, and did not occur without subtalar subluxation/dislocation.

Conclusions:

• The tibial nerve is at significant risk of injury following displaced talar neck fractures, especially in cases of tibiotalar subluxation/dislocation and open fractures.
• Higher Hawkins grades correlate with an increased risk of TND.
• Early identification and management of TND are important for optimizing outcomes in patients with talar neck fractures.