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  • Title: [Surgical treatment of open fractures of the talus].
    Author: Fang LM, Wang JQ, Zhang J, Zheng JY, Zhang SX, Wang Y.
    Journal: Zhonghua Yi Xue Za Zhi; 2007 Nov 06; 87(41):2899-904. PubMed ID: 18261303.
    Abstract:
    OBJECTIVE: To evaluate the long-term outcomes of surgical treatment of open fracture of talus. METHODS: Sixteen patients with displaced open fractures of the talus, including 3 cases of type 1, 8 of type 2, 2 of type 3A, 2 of type 3B, and 1 of type 3C according to the Gustilo-Anderson classification system, 15 males and 1 female, aged 37.5 (21 - 48), were treated with open reduction and stable internal fixation within 6 - 8 hours after injury, and followed up for 3.2 years (3 - 6 years). There were 7 cases of pure displaced talar neck or body fracture and 9 cases of fractures associated with an ipsilateral pilon, ankle, and calcaneus totally that included 2 cases of type 2, 3 of type 3, and 1 of type 4 according to the Hawkins classification system modified by Canale. RESULTS: The union rate was 81% (13/16) with the average union time of 4.5 months. Three cases failed to heal and developed osteomyelitis, of which 2 were treated with late talectomy because of septic nonunion. One case underwent amputation below-the-knee because of instability and pain. Osteonecrosis developed after seven of the nineteen closed fractures, whereas posttraumatic arthritis developed after all nineteen. Osteonecrosis developed in 11 (68%), and posttraumatic arthritis developed in 13 of the 16 cases (85%). The average American Orthopaedic Foot and Ankle Society score of these patients was 43.7 points. CONCLUSION: Open fractures of the talus has a low union rate, a higher osteonecrosis rate, and substantially higher reoperation and infection rates. Posttraumatic arthritis is a more common complication than osteonecrosis following operative treatment. Open reduction and internal fixation are recommended for the treatment of open fractures of talus.
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