Multifocal percutaneous pin fixation of talar neck fractures: An alternative to ORIF in the polytraumatized patient

Abstract

Purpose: Unique anatomy, precise articulations, fragile vascularity, and the demand for anatomic reduction make talar neck fractures challenging to treat, whether with screws and/or plates. Multifocal percutaneous pin fixation (MPPF) offers an alternative to ORIF, particularly in the polytraumatized patient. Methods: Unless an open lateral wound or medial malleolus fracture was present, a standard anteromedial approach was performed. K-wires placed within the talar head were used as joysticks to facilitate and finalize reduction. At least 3 wires were placed medially and 2 laterally across the talar neck. Incisions were closed in 2 layers, and either a well-padded short leg splint or adjunctive ankle-spanning external fixation was utilized. Patients remained non-weightbearing until K-wire removal in the office at approximately 6–8 weeks postoperatively. Results: MPPF was performed in 7 patients, the majority of whom were female (6 of 7). The average patient age at the time of injury was 30.3 years (range 17–51 years). The median time of final follow up was 27 months. Comminution was present in all patients. Avascular necrosis (AVN) developed in 3 patients and non-union occurred in 2 patients. All patients developed subtalar posttraumatic arthritis, and 6 additionally developed tibiotalar arthritis. No patients underwent talectomy or osteotomy, and there were no superficial pin site infections or loosening of pins prior to scheduled removal. Conclusions: Obtaining and maintaining an adequate reduction is possible with minimal soft tissue compromise through MPPF. Despite the complexity of the series, outcomes utilizing MPPF are comparable to those reported in the literature.

Keywords

• MPPF
• ORIF
• Percutaneous pinning
• Polytrauma
• Talar neck
• Damage control