Talar Neck Fractures With Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis

OBJECTIVES: To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck fractures (ITNs). METHODS: Design: Retrospective Cohort Setting: Single Level I Trauma Center Patient Selection Criteria: Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least six months follow-up. Based on radiographs at the time of injury, fractures were classified as ITN or TNIFAF and by Hawkins classification. Outcome Measures and Comparisons : The primary outcome was the development of AVN based on follow-up radiographs, with secondary outcomes including nonunion and collapse. RESULTS: There were 115 patients who sustained talar neck fractures, with 63 (55%) in the ITN group and 52 (45%) in the TNIFAF group. In total, 63 (54.7%) patients were female with mean age of 39 years (range, 17-85), and 111 (96.5%) fractures occurred secondary to high-energy mechanisms of injury. There were no significant differences in demographic or clinical characteristics between groups ( p >0.05). Twenty-four (46%) patients developed AVN in the TNIFAF group compared to 19 (30%) patients in the ITN group (p = 0.078). After adjusting for Hawkins classification and other variables, the odds of developing AVN was higher in the TNIFAF group compared to the ITN group Odds Ratio, 2.43 (95% CI, 1.01-5.84); (p = 0.047). CONCLUSIONS: This study found a significantly higher likelihood of AVN in patients with talar neck fractures with concomitant ipsilateral foot and/or ankle fractures compared to those with isolated talar neck fractures after adjusting for Hawkins classification and other potential prognostic confounders. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.