Talar Neck Fracture ORIF
Edited by Daniel Guss, MD, M.B.A.
Indications
A talar neck fracture ORIF is indicated for patients with a talar neck fracture and the bone fragments are displaced, or not well aligned.
Procedure
The goal of this procedure is to reposition the talus back in the exact position it was in prior to surgery (anatomically align the fracture), and secure it in this position with screws or a plate. The procedure is usually performed using 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 temporarily held in place with wires, and subsequently fixed with screws or a plate to hold the pieces in appropriate alignment as the talus heals. Two incisions are used to ensure that the tube-shaped talar neck has been accurately repositioned on both sides. This is especially important if the talus has fractured into multiple small pieces.
If the talar neck fracture is an open injury (bone has broken through the skin) or if it is dislocated (the lower bone of the ankle has dislocated out of the ankle joint), it must be treated urgently with surgery. These are more severe injuries and are more likely to result in complications.
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. Early weight-bearing can displace the fracture, producing a malunion (heals in the wrong position) and/or anon-union (fails to heal) at the fracture site.
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). Loss of blood supply becomes much more likely if the talus dislocated during the original injury, and can lead to persistent pain and arthritis.
After the fracture has healed (typically 8-12 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 18-24 months before the patient reaches the 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 is supplied to the talus 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). This becomes even more likely if the talus itself dislocates, or moves out of place, because the blood vessels get kinked or torn. 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 (arthritis below the ankle joint). 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
- Stiffness. Some degree of ankle (up and down motion) or subtalar (side to side motion) stiffness is common after talar neck fractures, especially in more severe injuries that include dislocation.
Edited July 11, 2017
mf/4.2.18