Analysis of therapeutic methods and effects for talar fractures

Objective:To explore the choice of therapeutic methods for talar fractures and analyze its clinical effects.Methods:From October 1998 to October 2009,44 patients with talar fractures were treated in the study,of them,38 cases obtained follow up,in which 10 cases with plaster external fixation,22 cases with open reduction and internal fixation,6 cases with Blair joint fusion.There were 28 males and 10 females,ranging in age from 19 to 65 year with an average of 33.5 years.According to classification of Matti-Weber,typeⅠwas in 3 cases,typeⅡin 15,type Ⅲin 16,type Ⅳin 4.The clinical effects were evaluated by the Hawkins standard including pain,active range of the joint,limping.Results:The mean time of follow up was 4.8 years(range,1 to 11 years).According to the Hawkins standard,in 10 cases with plaster external fixation,4 cases obtained excellent results,2 good,3 fair,1 poor;in 22 cases with open reduction and internal fixation,2 case obtained excellent results,6 good,6 fair,8 poor(the 8 patients accepted second treatment with joint fusion at 3 to 5 years after operation,affected limb of 1 patient occurred crispation for 3 cm,walking with limp,and further treatment was refused result in poor,and others got fair results);in 6 cases with Blair joint fusion,1 case obtained good results,4 fair,1 poor.Diaz disease was found in 12 cases and traumatic arthritis was found in 13 cases in the period of follow up.Conclusion:Talar fracture usually results in complications and gets bad prognosis.The prognosis is relative with the traumatic degree.Plaster external fixation beseems to the displacement of fracture less than 2 mm;open reduction and internal fixation beseems to the displacement of fracture more than 2 mm;Blair joint fusion beseems to talar body fracture with total dislocation or whose talar body fracture is comminuted severely and the surface of joint can not be repaired.