Effectiveness analysis of percutaneous parallel screw fixation via posterolateral “safe zone” for Hawkins type <b>Ⅰ</b>-<b>Ⅲ</b> talar neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

NIE Guanghua , YANG Xinquan , ZHANG Yan , WANG Xinwen , WEN Xiaodong ,  ZHAO Hongmou

Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding author：

ZHAO Hongmou, Email: zhao_hongmou@hotmail.com

Keywords：

Talar neck fracture; screw fixation; percutaneous internal fixation; open reduction internal fixation; Hawkins sign

DOI：

10.7507/1002-1892.202308073

Video：

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Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). Conclusion The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Citation： NIE Guanghua, YANG Xinquan, ZHANG Yan, WANG Xinwen, WEN Xiaodong, ZHAO Hongmou. Effectiveness analysis of percutaneous parallel screw fixation via posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1347-1352. doi: 10.7507/1002-1892.202308073 Copy

1.	Lee C, Brodke D, Perdue PW, et al. Talus fractures: Evaluation and treatment. J Am Acad Orthop Surg, 2020, 28(20): e878-e887.
2.	Giordano V, Liberal BR, Rivas D, et al. Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation-systematic review and meta-analysis. Injury, 2021, 52 Suppl 3: S89-S96.
3.	李岩, 罗鸣, 袁志. 距骨骨折的治疗原则及进展. 中华创伤骨科杂志, 2021, 23(4): 329-336.
4.	Parmeshwar SS, Sharma SL, Sharma A, et al. A comparative study of three different approaches in treatment of talar neck fractures. J Clin Orthop Trauma, 2022, 37: 102092.
5.	Beltran MJ, Mitchell PM, Collinge CA. Posterior to anteriorly directed screws for management of talar neck fractures. Foot Ankle Int, 2016, 37(10): 1130-1136.
6.	Wang Z, Qu W, Wang D, et al. Talar neck fractures: anatomic landmarks of suitable position for posterolateral screw insertion. Acta Orthop Traumatol Turc, 2015, 49(3): 326-330.
7.	Fan Z, Ma J, Chen J, et al. Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis. J Orthop Surg Res, 2020, 15(1): 45.
8.	Wu JQ, Ma SH, Liu S, et al. Safe zone of posterior screw insertion for talar neck fractures on 3-dimensional reconstruction model. Orthop Surg, 2017, 9(1): 28-33.
9.	Tezval M, Dumont C, Stürmer KM. Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma, 2007, 21(8): 538-543.
10.	Lam CL, Tse EY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res, 2005, 14(2): 539-547.
11.	Oppermann J, Franzen J, Spies C, et al. The microvascular anatomy of the talus: a plastination study on the influence of total ankle replacement. Surg Radiol Anat, 2014, 36(5): 487-494.
12.	Vallier HA. Fractures of the talus: State of the art. J Orthop Trauma, 2015, 29(9): 385-392.
13.	Xue Y, Zhang H, Pei F, et al. Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. Int Orthop, 2014, 38(1): 149-154.
14.	Dodd A, Lefaivre KA. Outcomes of talar neck fractures: A systematic review and meta-analysis. J Orthop Trauma, 2015, 29(5): 210-215.
15.	Ebraheim NA, Mekhail AO, Salpietro BJ, et al. Talar neck fractures: anatomic considerations for posterior screw application. Foot Ankle Int, 1996, 17(9): 541-547.
16.	Zhang X, Shao X, Yu Y, et al. Comparison between percutaneous and open reduction for treating paediatric talar neck fractures. Int Orthop, 2017, 41(12): 2581-2589.
17.	范峥睿, 王颖, 匡明杰, 等. 距骨颈骨折双螺钉固定力学稳定性的三维有限元分析. 中华创伤杂志, 2019, 35(6): 543-548.
18.	Sangeorzan BJ, Wagner UA, Harrington RM, et al. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res, 1992, 10(4): 544-551.
19.	范峥睿, 马剑雄, 王颖, 等. 基于三维重建模型的国人距骨的内偏角及跖倾角测量. 中华医学杂志, 2020, 100(19): 1480-1483.

1. Lee C, Brodke D, Perdue PW, et al. Talus fractures: Evaluation and treatment. J Am Acad Orthop Surg, 2020, 28(20): e878-e887.
2. Giordano V, Liberal BR, Rivas D, et al. Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation-systematic review and meta-analysis. Injury, 2021, 52 Suppl 3: S89-S96.
3. 李岩, 罗鸣, 袁志. 距骨骨折的治疗原则及进展. 中华创伤骨科杂志, 2021, 23(4): 329-336.
4. Parmeshwar SS, Sharma SL, Sharma A, et al. A comparative study of three different approaches in treatment of talar neck fractures. J Clin Orthop Trauma, 2022, 37: 102092.
5. Beltran MJ, Mitchell PM, Collinge CA. Posterior to anteriorly directed screws for management of talar neck fractures. Foot Ankle Int, 2016, 37(10): 1130-1136.
6. Wang Z, Qu W, Wang D, et al. Talar neck fractures: anatomic landmarks of suitable position for posterolateral screw insertion. Acta Orthop Traumatol Turc, 2015, 49(3): 326-330.
7. Fan Z, Ma J, Chen J, et al. Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis. J Orthop Surg Res, 2020, 15(1): 45.
8. Wu JQ, Ma SH, Liu S, et al. Safe zone of posterior screw insertion for talar neck fractures on 3-dimensional reconstruction model. Orthop Surg, 2017, 9(1): 28-33.
9. Tezval M, Dumont C, Stürmer KM. Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma, 2007, 21(8): 538-543.
10. Lam CL, Tse EY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res, 2005, 14(2): 539-547.
11. Oppermann J, Franzen J, Spies C, et al. The microvascular anatomy of the talus: a plastination study on the influence of total ankle replacement. Surg Radiol Anat, 2014, 36(5): 487-494.
12. Vallier HA. Fractures of the talus: State of the art. J Orthop Trauma, 2015, 29(9): 385-392.
13. Xue Y, Zhang H, Pei F, et al. Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches. Int Orthop, 2014, 38(1): 149-154.
14. Dodd A, Lefaivre KA. Outcomes of talar neck fractures: A systematic review and meta-analysis. J Orthop Trauma, 2015, 29(5): 210-215.
15. Ebraheim NA, Mekhail AO, Salpietro BJ, et al. Talar neck fractures: anatomic considerations for posterior screw application. Foot Ankle Int, 1996, 17(9): 541-547.
16. Zhang X, Shao X, Yu Y, et al. Comparison between percutaneous and open reduction for treating paediatric talar neck fractures. Int Orthop, 2017, 41(12): 2581-2589.
17. 范峥睿, 王颖, 匡明杰, 等. 距骨颈骨折双螺钉固定力学稳定性的三维有限元分析. 中华创伤杂志, 2019, 35(6): 543-548.
18. Sangeorzan BJ, Wagner UA, Harrington RM, et al. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res, 1992, 10(4): 544-551.
19. 范峥睿, 马剑雄, 王颖, 等. 基于三维重建模型的国人距骨的内偏角及跖倾角测量. 中华医学杂志, 2020, 100(19): 1480-1483.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures

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