The Publications Book
The Heidari Publications
94 publications · 23 years of research · click or drag a page corner to turn
Royal College
British Orthopaedic
AO Trauma
Churchill
Limb Recon
Specialist Reg.
Pradhan A, Najefi A, Patel A, Vris A, Heidari N, et al.
BACKGROUND: Talus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. METHODS: We retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. RESULTS: The mean age was 35 years (range: 18-76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. CONCLUSION: Our study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated.
What did we look at?
The real-world complication rates after fractures of the talus (one of the small bones at the back of the foot, just below the ankle joint) over an 8-year window at our trauma centre.
Why did we look at it?
Talus fractures are uncommon but feared. The blood supply to the talus is fragile, and a fractured talus is at risk of avascular necrosis (death of the bone) and post-traumatic arthritis. Patients ask, reasonably, what their personal risk is.
What did we find?
Across 100 consecutive talus fractures: average age 35, with 22% sustaining open injuries. Talar body fractures were most common (47%); neck fractures (20%) carried the highest complication risk. Overall: non-union 2%, avascular necrosis 6%, and tibio-talar post-traumatic arthritis 12%. Open injuries had higher rates of complications across the board.
What does this mean for patients?
If you fracture your talus, the headline numbers to keep in mind are: about 1 in 16 chance of avascular necrosis, about 1 in 8 chance of arthritis. Higher if your fracture was open or involved the neck of the talus.
Injury 2023. PMID: 36543737.