A Clinical Study Of The Fractures Of Talar Necks Treated By Two Surgery Approaches

Objective:To comparing the clinical outcome and effects the anteromedial incision approach and dual incisions approach in the treatment of talar neck fractures: a retrospective studyMethods:From June 2006 to September 2013,36 patients with the talar neck fractures were treated in Chinese medicine hospital of Changzhou, Among them, 31 cases of operation patients with complete follow-up data.The operative approach includes the anteromedial incision approach and dual incisions approach. According to the approach of operations, we divided them into two groups: single incision group(15 cases), dual incisions group(16 cases). One year after the operations, we calculated and compared fracture healing rates, the incidence rates of posttraumatic arthritis and avascular necrosis, the excellent and good rates of Hawkins, VAS scores and AOFAS scores of the two groups by the statistical methods.Results:One year after the operations, the overall fracture healing rate of the 31 patients was 77.42%, in which the single incision group was 93.33%, the dual incisions group was 62.50%, and the fracture healing rate of the single incision group was higher than that of dual incisions, the difference was statistically significant(P < 0.05). One year after the operations, the overall incidence rate of posttraumatic arthritis is 29.03%, in which the single incision group was 46.67%, the dual incisions group was 12.50%, and the incidence rate of posttraumatic arthritis of the single incision group was higher than that of dual incisions, the difference was statistically significant(P < 0.05). One year after the operations, the overall incidence rate of avascular necrosis is 16.13%, in which the single incision group was 13.33%, the dual incisions group was 18.75%, and there were no statistical difference between the two groups in avascular necrosis(P > 0.05). According to Hawkins efficacy evaluation one year after the operations, the overall excellent and good rate was 61.29%, in which the single incision group was 51.33%, the dual incisions group was 68.75%, and there were no statistical difference between the two groups of the excellent and good rate(P > 0.05). One year after the operations, the VAS scores and AOFAS scores of the single incision group were 6.04±0.75 and 42.84±10.16; that of the dual incisions group were 3.28±0.42 and 61.24±11.8, and VAS scores of the single incision group was higher than that of the dual incisions group, but AOFAS scores of it was lower than that of the dual incision group, the difference was statistically significant(P < 0.05).Conclusion:One year after the talar neck fractures treated by surgery, the fracture healing rate of single incision is higher than dual incisions approach; but the incidence rate of posttraumatic arthritis is also higher than that of the dual incisions approach. There is no statistical significance between the two surgery approaches in the incidence rate of avascular necrosis and excellent and good rate of Hawkins efficacy evaluation. The two surgery approaches do have advantages and disadvantages, we should choose proper approach based on the preoperative datas and intraoperative findings...