[Late results of central talus injuries]

From 1982 to 1992 we treated 66 talar injuries at our institution, 44 of which were central fractures (25 talar neck fractures, 17 corpus fractures, 1 comminuted fracture and 1 complete dislocation of the intact talus). In 77% of patients additional injuries were present; 34% were polytraumatized. In 41 patients (93%) clinical and radiological follow-up was possible after an average of 6.3 years. All displaced fractures were treated by open reduction (84%) and, usually, screw fixation, 41% of these within 6 h after the accident. Only 1 required an osteotomy of the medial malleolus, and in 4 a cancellous bone graft was performed. Non-displaced fractures were treated by plastering and partial weight-bearing for an average of 3.1 months. This regime made it possible to contain the rate of aseptic necrosis of the talar body at 12%. The infection rate was 5%. Degenerative changes of the tibiotalar and subtalar joints were seen in 34%. Although there were no cases of non-union and only 2 of malunion, we observed only 6 patients (15%) with complete functional recovery (painfree, normal gait, full professional and recreational activities). A good result (start-up pain, slight limp) was seen in 15 (37%), and a fair result (pain on walking, but normal gait) was achieved in 7 (17%). We observed 13 patients (32%) who had pain on walking and/or at rest and a definite limp at follow-up examination. The average time off work was 8.7 (2.3-26) months. A poor result was associated with additional injuries and subtalar osteoarthritis.(ABSTRACT TRUNCATED AT 250 WORDS)