Impact of fixation method on avascular necrosis in talar neck fractures: a retrospective analysis

To compare clinical outcomes and complication rates between plate with independent screw fixation versus screw fixation alone in the management of talar neck fractures (AO/OTA 81.2), with a primary focus on avascular necrosis (AVN).

A retrospective review was performed of adult patients who underwent operative fixation of talar neck fractures at a single Level I trauma center between 2017 and 2022, with a minimum follow-up of 3 months. Patients were divided into screw fixation alone (S) and plate with independent screw fixation (PS) groups. The primary outcome was avascular necrosis (AVN). Secondary outcomes included fracture union, post-traumatic arthrosis (PTA), infection, and unplanned reoperation. Multivariable logistic regression was performed to identify factors associated with AVN.

Seventy patients were included (33 S, 37 PS) with no differences in baseline demographics, comorbidities, or injury characteristics (p > 0.05). Union rates were similar between groups (p = 0.23). The incidence of AVN was significantly higher in the S group compared to the PS group (52% vs 22%, p = 0.01). There were no differences in rates of PTA, infection, or reoperation (p > 0.05). On multivariable analysis, plate fixation was associated with a significantly lower likelihood of AVN (OR 0.16, 95% CI 0.03-0.70; p < 0.01).

In this retrospective cohort, plate with independent screw fixation was associated with a significantly lower risk of avascular necrosis compared to screw fixation alone in talar neck fractures, while maintaining similar union and complication rates.