Union Rates of Talar Neck Fractures With Substantial Bone Defects Treated With Autograft

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Bone Grafting Techniques

Background:

• Talar neck fractures with significant bone loss present a challenge in achieving union.
• Autologous tibial bone grafting is a surgical option for reconstructing these defects.

Purpose of the Study:

• To evaluate the union rate and secondary outcomes of talar neck fractures with substantial bone defects treated with autologous tibial bone graft.
• To assess complications such as malunion, avascular necrosis, and post-traumatic arthritis.

Main Methods:

• A case series of 12 patients with talar neck fractures and substantial bone defects treated with primary osteosynthesis and autologous tibial bone graft.
• Fracture classification, operative details, and postoperative outcomes including union, malunion, avascular necrosis (AVN), post-traumatic arthritis (PTA), and patient-reported outcomes (PROs) were analyzed.
• Substantial bone defect defined as >5mm sagittal gap and >1/3 width in coronal plane.

Main Results:

• Excellent union rate of 92% (11/12 patients) was achieved.
• High incidence of avascular necrosis (AVN) at 92% (11/12 patients), with 33% experiencing collapse.
• Radiographic evidence of post-traumatic arthritis (PTA) was common: 83% ankle, 100% subtalar.
• Patient-reported outcomes were generally fair to poor.

Conclusions:

• Autologous tibial bone grafting in primary osteosynthesis of comminuted talar neck fractures with substantial defects yields high union and low malunion rates.
• Despite good union, high rates of AVN, PTA, and suboptimal patient-reported outcomes necessitate further investigation and management strategies.