Talar head fractures: An observational study of 33 talar head fractures derived from the Swedish Fracture Register.

BACKGROUND

Reports in the literature on talar head fractures are rare and limited to case reports and small case series.

QUESTIONS/PURPOSES: This study aimed to describe a national cohort of talar head fractures for fracture characteristics, associated injuries, treatment, and reoperations.

METHODS

We reviewed all radiographs of patients enrolled in the SFR between 2011 and 2021 showing talar head fractures (AO/OTA 81-A3). We excluded those with talar head avulsion fractures, misclassified, multiple registrations, or with a privacy notice in their medical records. The cohort was reviewed using medical records and radiographs at a minimum 2-year follow-up.

RESULTS

The study included 32 patients (33 fractures) ≥18 years of age. The median age was 32 (range 18-65) years, 84 % were men, and the main trauma mechanisms were motor vehicle accidents (28 %) and falls from heights (28 %) and graded as high-energy injuries in 50 % of the cases. 18 (55 %) were displaced and 15 (45 %) had comminuted fractures. 14 talar head fractures (42 %) had multiple injuries to the same foot. 21 patients (66 %) underwent surgical treatment, most commonly with screw fixation. Surgery was performed in 15 of 18 patients with displaced fractures. Four patients were reoperated, one with arthrodesis of the talonavicular joint and three for implant removal. No cases of avascular necrosis were identified.

CONCLUSIONS

Talar head fractures are rare and occur mainly in men. They are associated with other foot injuries. Most talar head fractures are treated operatively. In this case series, we did not identify any case of avascular necrosis.

LEVELS OF EVIDENCE: IV, retrospective observational cohort study.