FUNCTIONAL RESULTS AFTER OPERATIVE TREATMENT OF TALUS FRACTURES

ФУНКЦИОНАЛНИ РЕЗУЛТАТИ ПО ОПЕРАТИВЕН ТРЕТМАН НА ФРАКТУРИ НА ТАЛУС Andreja Gavrilovski1, Aleksandra Dimovska-Gavrilovska2, Goran Aleksovski1 1 University Clinic for Traumatology, Orthopedics, Anesthesiology, Reanimation and Intensive Care Skopje; Ss. Cyril and Methodius University, Faculty of Medicine, Skopje, Republic of North Macedonia 2 University Clinic for Neurosurgery, Ss. Cyril and Methodius University, Faculty of Medicine, Skopje, Republic of North Macedonia


Specific and vascularity
The blood supply to the talus is highly specific since almost 60% of its surface is cartilaginous; only a small portion of the talus may be perforated by blood vessels. There is a ring of blood vessels around the head and neck of the talus, consisting of the anterior and posterior tibial artery and perforated peroneal arteries. If those areas of nutritional artery entry are disrupted, avascular necrosis and subsequent ankle arthrosis can easily occur 2 . The most common mechanism for these fractures to occur is forced dorsiflexion with axial loading. Accompanying fractures may be bimalleolar fractures, namely medial malleolar fractures.
The purpose of this study was to evaluate and compare the shortterm and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures.

Materials and methods
In the period between 2017 and2020, 14 patients with talus fractures were surgically treated at the University Clinic for Traumatology. Of these, 10 were male patients and 4 female patients. The mean age of the patients was 44 years. Only patients who met the inclusion criteria, operatively treated fractures, and signed consent to participate in the study were included in this study.
The study included patients with talus fractures who met the following inclusion factors:
The classification was made on the basis of computed tomography images taken from all patients. Of the 14 patients, 5 had an associated fracture of the medial malleolus.
All patients underwent open reduction and internal fixation with screws (Picture 1) or reconstructive plate (Picture 2). Postoperatively all patients had immobilization during the next 14 days. Three patients underwent revision due to an inad-equate primary reduction seen on the postoperative CT scans.
All patients were postoperatively treated with LMWH, antibiotic therapy for 5 days, and analgesic therapy.
Follow-up was done on the 14 th postoperative day, 1 st month, 3 rd month and 6 th month. X-rays were taken on the 1 st month, 3 rd month and 6 th month, except on the first follow-up, where the sutures were removed.
At the 6 th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society 4 . The following nine parameters were evaluated: 1. Pain -(no pain, mild pain, intermittent pain, persistent pain); 2. Function -(without restrictions or walking using a helping device); 3. Walking distance -(from being able to walk less than1 km to more than 6 km); The maximum score of the Kitaoka score system is 100 points, excellent (100-85), good (85-65), unsatisfactory (65-45) and bad (> 45) 5 .
Of the 14 respondents, excellent result had 2 patients (mean result of 86.5), and good result was found in 8 patients (mean result of 68).An unsatisfactory result had 3 patients (mean score of 48.5) and a bad result in one patient (38 points).
Early complications were postoperative skin problems (areas of necrosis in the area of the operative wound) in 4 patients.

Discussion
This injury is too rare for conclusions to be brought out and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions that the treatment of these fractures is complex. It depends a lot on achieving absolute anatomical reduction, but the outcome may still be unsatisfactory due to the complex biology of this tarsal bone. If the nutritional part of the talus is fractured, it should be operated on in the first 24 hours following injury 8,9 .

Conclusion
At our Clinic, time till surgery is not taken into account as a direct factor to the outcome of the treatment of certain types of talar fractures. Anatomical reduction is mandatory for a better outcome. A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.