Treatment of talus neck fracture with talus dislocation by using all ankle arthroscopic fracture reduction and hollow screw fixation
Zhang Shucai1, Zhai Deping2, Hao Yunjia1, Fan Jiaqiang1, Tao Youlun1, Chang Buqing1, Zhang Zaiyi1, Wang Aiguo1
1Department of Foot and Ankle Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou 221009, China; 2Department of Pediatric Center, Xuzhou Central Hospital, Xuzhou 221009, China
Abstract:Objective This study aimed to investigate the clinical effect of total ankle arthroscopic fracture reduction and cannulated screw fixation in the treatment of talus neck fracture with talus dislocation. Methods A retrospective study was conducted. From January 2019 to December 2020, 23 patients of talus neck fracture with talus dislocation in the Hand and Foot Microsurgery Department of Xuzhou Central Hospital were included in this study, including 15 males and 8 females aged 18-56 (29.4±10.2) years. On the basis of modified Hawkins classification, 17 and six cases were identified as types Ⅱ and Ⅲ, respectively. In addition, 10 and 13 cases were on the left and right sides, respectively, and the time from injury to operation was 2-9 (4.1±2.6) days. All patients underwent fracture reduction under ankle arthroscopy and percutaneous cannulated screw internal fixation. X-ray films were regularly reviewed after the operation to observe the fracture reduction, internal fixation, fracture healing, and complications, such as nonunion, malunion, avascular necrosis, and traumatic arthritis. The ankle range of motion was observed during the follow-up period, along with foot appearance satisfaction and walking gait. The visual analog scale (VAS) score of the patients' ankle joint pain and the American Foot and Ankle Surgeon Association Ankle and Hindfoot Scoring System (AOFAS) score were compared between pre-operation and final follow-up. The AOFAS score was used to evaluate the ankle function of the patients during follow-up. Results The operation success rate was 95.6%, the operation time was 50-100 (73.21±18.32) min, the intraoperative blood loss was 5-10 (7.10±1.31) mL, the hospitalization time was 6-14 (8.41±2.03) days, and the surgical incision of all patients was one stage. All fractures healed without complications, such as vascular, nerve, and tendon injuries. All the 23 patients were followed up for 12-20 (15.71±4.63) months. Postoperative X-rays showed that all patients had anatomical reduction of the talus, and no complications, such as talus nonunion, malunion, avascular necrosis, and traumatic arthritis, were found. All fractures healed for 10-14 (11.63±2.10) weeks. At the last follow-up, except for one patient with reduced ankle range of motion (approximately 5° of dorsiflexion and approximately 30° of plantar flexion), the patients had good ankle motion, satisfactory appearance, no abnormal walking gait, and no hyperesthesia in the local skin of the incision and scar tenderness. At the last follow-up, the VAS score of the patients' ankle pain was 0-2 (0.65±0.71), which was lower than the preoperative score of 3-9 (6.08±1.47). The AOFAS score was 88-99 (94.34±2.53), which was higher than the preoperative score of 59-81 (71.30±6.73). The differences were statistically significant (t=15.32,-16.72; all P values <0.05). The AOFAS score indicated 20 and two cases of excellent and good ankle joint functions after the operation, respectively, and the excellent and good rates were 100%. Conclusion Total ankle arthroscopic fracture reduction with cannulated screw fixation is a minimally invasive technique that has the advantages of precise reduction under direct vision, less trauma, less blood supply damage, and avoidance of the occurrence of complications of traditional surgical incisions. It is an effective treatment method for talus neck fracture with talus dislocation.
张述才, 翟得平, 郝云甲, 范家强, 陶友伦, 常步青, 张在轶, 王爱国. 全踝关节镜下骨折复位空心螺钉固定术治疗伴距骨脱位距骨颈骨折的疗效观察[J]. 中华解剖与临床杂志, 2022, 27(10): 709-714.
Zhang Shucai, Zhai Deping, Hao Yunjia, Fan Jiaqiang, Tao Youlun, Chang Buqing, Zhang Zaiyi, Wang Aiguo. Treatment of talus neck fracture with talus dislocation by using all ankle arthroscopic fracture reduction and hollow screw fixation. Chinese Journal of Anatomy and Clinics, 2022, 27(10): 709-714.
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