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[Treatment of shearing-type and comminuted talar body fractures].

OBJECTIVE
To study the treatment and therapeutic effects in the shearing-type and comminuted talar body fractures.


METHODS
From October 1988 to September 2005,34 patients with shearing-type or comminuted talar body fractures were followed up. There were 19 males and 15 females ranged from 13 to 55 years (averaged 28.8 years). The disease course ranged from 3 to 14 days (averaged 6.0 days). Ten patients with a displacement of no more than 3 mm were treated with plastic cast. Eighteen patients were treated with open reduction and internal fixation, 6 patients were treated with joint fusion. The assessment of clinical efforts depend on patients' ache, active range of the joint and limp.


RESULTS
The mean follow up was 5.04 years (ranged from 3 to 19 years). All the patients were healed. The clinical outcomes were evaluated according to Hawkins evaluation score in which ache, active range of the joint and limp was respectively acssessed. There were 6 patients reached an excellent result, 9 good, 11 fair and 8 poor. Fifteen patients had osteonecrosis, 18 patients had traumatic arthritis of ankle joint, and 14 patients had traumatic arthritis of subtalar joint.


CONCLUSION
Patients whose displacement of fracture is not more than 3 mm should be treated with plastic cast. Operation and internal fixation should be performed in patients whose displacement of fracture is more than 3 mm after close reduction. Joint fusion should be performed in patients whose talar body fracture is comminuted severely and the surface of joint can not be repaired. The patients of talar body scissored fracture or comminuted fracture has bad prognosis.