Incidence of Avascular Necrosis 6 Months after Operative Talus Fracture

Introduction: Talus fracture is a rare injury associated with significant morbidity due to its complex structure and tenuous vascular supply, which predisposes it to complications such as avascular necrosis (AVN) and post-traumatic arthritis (PTA). A variable rate of AVN exists in the literature, due to recent advances in operative management. We aimed to determine the rate of AVN as well as outcomes in talus fracture after operative management. Methods: We performed a retrospective review (1/2014-6/2022) of patients ≥18 years of age with talus fracture at a Level I trauma center. Patients with <6 months of postoperative data were excluded. Demographics, injury characteristics, fracture classifications and treatment approaches were compared. The primary outcome was AVN after operative repair. Secondary outcomes included PTA, sepsis, amputation, and other complications. Results: Thirty-four patients were included in the study, 3 of which had an open injury. Seventy percent of patients had concomitant injuries with 11 to the same extremity. Half the patients developed a complication: PTA (n = 11, 32.35%), infection (n = 3, 8.82%), osteomyelitis (n = 3, 8.82%); and AVN (n = 4, overall rate 11.76%). Time from arrival to index operation did not increase the likelihood of AVN (p = 0.6158). All patients with AVN had temporary external fixation (p = 0.011). None of the patients with initial definitive fixation developed AVN (p = 0.024). Table 1 demonstrates the differences between AVN and No AVN groups. Multivariate logistic regression models did not identify any significant predictors for AVN. Conclusion: Initial management of talus fracture with definitive fixation may lower the incidence of AVN and the need for additional operative intervention (Table Presented).