Outcomes of Modified Blair Fusion in Avascular Necrosis Following Talar Fractures

Avascular necrosis (AVN) of the talus is a challenging complication following talar fractures. The modified Blair fusion technique, which preserves the talar body and enhances fixation, has emerged as a viable salvage procedure. However, data on outcomes remain limited.

We present data of 10 patients with post-traumatic AVN of the talus following talar neck/body fractures, who underwent modified Blair fusion. Two patients were stabilized with an Ilizarov fixator, while 8 were fixed with wires, screws, or plate and screw constructs. The primary outcomes included the AOFAS score and radiological. Secondary outcomes include the nature and rate of complications.

Fusion was achieved in 9 patients. All cases that fused showed evidence of revascularization of the necrotic talar body. The mean preoperative AOFAS score (measured on a scale from 0 to 86) was 41.5 ± 10.2 (range, 18-56) and improved to 70.0 ± 6.9 (range, 58-83) at the final follow-up (P = 0.0001). Arthrosis of the subtalar joint was noted in 5 patients. One patient had residual varus deformity. Superficial infection and deep infection were noted in one case each. The mean follow-up duration was 5.9 ± 6.1 years (range, 1-18 years).

Modified Blair fusion with preservation of the necrotic head provides a reliable salvage option in patients with complications and arthrosis after complex talus fractures. Saving the talus body contributes to the stability of the reconstruction, while maintaining the distance between the tibia and calcaneus, with evidence of subsequent revascularization and subtalar joint remodeling seen on a long-term follow-up.