Talar Neck ORIF
Indications
This surgery is indicated for patients with a displaced talar neck fracture.
Procedure
The goal of this procedure is to reposition the talus back in the exact position it was in prior to surgery (anatomically reduce the fracture) and secure it in this position with screws (and possibly a plate). The procedure is performed using at least two incisions: one located on the inside front aspect of the ankle (anteromedial ankle) and the second located on the outside front part of the ankle (anterolateral ankle). The talar neck fracture is identified; accurately reduced (put back in position); and then fixed in the position it was in prior to the injury. The fracture is first provisionally fixed with wires to hold it in position and then definitively fixed with screws (and a plate if necessary). The reason that two incisions are used is to ensure that the tube-shaped talar neck has been accurately repositioned on both sides.
If the the talar neck fracture is an open injury (bone has broken through the skin) or dislocated (the lower bone of the ankle has dislocated out of the ankle joint) it must be treated urgently with surgery.
Recovery
0-8 (or 12) weeks Post-Surgery
Immediately after the surgery, the patient is splinted in a cast with the foot flexed upwards (dorsiflexion position). The patient MUST remain non-weight bearing until the fracture heals. Weight-bearing prior to this can easily lead to displacement of the fracture producing a malunion and/or a non-union at the fracture site.
At 6-8 weeks post surgery it is common to take x-rays to assess for healing at the fracture site and to see if there is evidence of pending avascular necrosis of the talar body (loss of blood supply to the part of the talus that forms the lower part of the ankle joint).
After the fracture has healed (typically 6-12 weeks Post-Surgery)
After x-rays have demonstrated that the fracture has healed the patient can transition into a walking boot and begin weight bearing as tolerated. Activity at this point in time should be gradually increased. Eventually the patient will be able to transition into a comfort shoe and further increase their activity level.
Approximately 50-60% of the recovery is within the first 6 months. However, it will be about a 18-24 months before the patient reaches their point of maximal improvement.
Potential General Complications
Asymmetric Gait
Deep Vein Thrombosis (DVT)
Painful Hardware
Infection
Nerve Injury
Non-union
Pulmonary Embolism (PE)
Wound Healing Problems
Potential Specific Complications
Avascular Necrosis (AVN) of the Talar Body
The blood supply to the talus is through small blood vessels that run along or near the talar neck. Therefore a fracture to this area may lead to a loss of blood supply to part of (or all) of the talar body (the part of the talus directly under the ankle). When this occurs it is called avascular necrosis (AVN) of the talar body. If the talar body loses its blood supply the bone can soften and collapse when a new blood supply is re-established (usually 2-12 months post-injury). AVN with an associated collapse of the talar body invariably leads to ankle arthritis and/or subtalar arthritis. AVN of the talus is common after talar neck fractures. However, many patients have some AVN of the talus without collapse.
Malunion
If the talar neck fracture is not perfectly reduced, the foot may be potentially angulated or twisted in an abnormal manner
Edited August 11th, 2009