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- W4386945031 abstract "To identify patient, injury, and treatment factors associated with development of avascular necrosis (AVN)following talar fractures, with particular interest in modifiable factors.Retrospective chart review.21 US trauma centers and 1 UK trauma center.2,220 patients with talar neck and/or body fractures.Open reduction internal fixation of talar neck and body fractures.Development of AVN. Infection, nonunion, and arthritis were secondary outcomes.796 patients (408 M; 388 F; age 18-81, avg 38.6) with 796 (532R; 264L) fractures were included and were classified as Hawkins 1(51), IIA(71), IIB(113), III(158), IV(40), neck plus body (177), body (188). 336/798 developed AVN (42%), more commonly following any neck fracture (47.0%) vs isolated body fracture (26.1%, p<0.001). More severe Hawkins' classification, combined neck and body fractures, body mass index (BMI), tobacco smoking, right-sided fractures, open fracture, dual anteromedial and anterolateral surgical approaches, and associated medial malleolus fracture were associated with AVN. After multivariate regression, fracture type, tobacco smoking, open fractures, dual approaches, age, and BMI remained significant.Excluding late cases (>7 days), time to joint reduction for Hawkins type IIB-IV neck injuries was no different for those who developed AVN or not. AVN rates for reduction of dislocations within 6 hours of injury vs >6 hours were 48.8% and 57.5%, respectively. Complications included 60 (7.5%) infections and 70 (8.8%) nonunions.42% of all patients developed AVN, with talar neck fractures, more displaced fractures and open injuries having higher rates. Injury-related factors are most prognostic of AVN risk. Surgical technique to emphasize anatomical reduction, without iatrogenic damage to remaining blood supply is essential.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence." @default.
- W4386945031 created "2023-09-23" @default.
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- W4386945031 date "2023-09-20" @default.
- W4386945031 modified "2023-09-28" @default.
- W4386945031 title "Identifying risk factors for osteonecrosis after talar fracture" @default.
- W4386945031 doi "https://doi.org/10.1097/bot.0000000000002706" @default.
- W4386945031 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/37735752" @default.
- W4386945031 hasPublicationYear "2023" @default.
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