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Abstract
RÉSUMÉ
Introduction. Les fractures du talus sont relativement rares. Elles peuvent évoluer vers des complications pouvant compromettre le pronostic fonctionnel de la cheville. L’objectif de notre étude était d’évaluer cliniquement et radiologiquement la cheville après le traitement. Matériel et méthodes. C’est une étude prospective allant d’Octobre 2004 à Décembre 2008 à Dakar. Elle incluait 11 patients dont 13 lésions. Les fractures du corps du talus étaient observées dans 77% de cas et celles du col dans 23% de cas. Nous avons utilisé deux scores pour l’évaluation fonctionnelle. Au plan anatomo-radiologique, les épaisseurs de l’interligne tibiotalienne et sous talienne, puis la hauteur du corps du talus ont été mesurées en post opératoire immédiat et au moment de l’évaluation. Résultats. Le score moyen de l’AOFAS de nos patients était de 80,7 points sur 100 ; avec 3 résultats excellents, 4 bons résultats, 3 résultats satisfaisants et 1 mauvais résultat. Une diminution de la hauteur du corps du talus a été observée dans 90% de cas; celle des espaces sous talienne dans 60% de cas et tibiotalienne dans 40%. Les complications étaient présentes dans 60% de cas. L’arthrose et l’ostéonécrose avasculaire étaient observées respectivement dans 60% et 40% de cas. Conclusion. Le résultat fonctionnel après traitement dépend du type de lésion et de la qualité de la réduction de la fracture. Malgré un mauvais résultat radiologique, nous avons obtenu des résultats fonctionnels acceptables.
ABSTRACT
Introduction. Talar fractures are relatively rare. Our objective was to evaluate the functional and radiologic outcome of these fractures after treatment. Materials and methods. We carried out therefore a prospective study from October 2004 to December 2008 in Dakar. For the functional evaluation, we used the Hawkins’ score and the score of the American Orthopedic Foot and Ankle Society (AOFAS). X-rays were done immediately after the treatment and at the time of evaluation. On these radiographs, we measured the talar height and the supra- and infra-talar spaces. There were 11 patients and 13 lesions. The fractures of the talar body accounted for 77% whereas those of the neck were encountered in 23%. Results. The mean score using AOFAS’ scale was 80.7%. According to this score, we had 3 excellent results, 4 good ones, 3 satisfactory and 1 bad result. The two functional scores we used showed the same results. The radiologic evaluation revealed a shortening of the talar body’ height, the supra- and infra-talar spaces in respectively 90%, 40% and 60% of cases. Sixty per cent of cases were complicated. Post traumatic arthritis and avascular necrosis were seen in respectively 60% and 40% of cases. Conclusion. Although our radiologic results were bad, our functional outcome was acceptable.
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References
- -Adel El Sayed. Les fractures de l’astragale.Thèse de médecine, UCAD.N°5 1984.
- - Besch L et al. Treatment of rare talus dislocation fractures. An analysis of 23 injuries. Unfallchirurg. 2002 Jul ; 105(7) : 595-601.
- - Bonnomet F et al. Chirurgie des fractures du talus.Encycl Med Chir, Techniques chirurgicales, orthopédie-traumatologie. 1995: 44-885
- - Coltart WD et al. Aviator’s astragalus. J Bone Joint Surg Br. 1952; 34: 545-566.
- - David W, Sanders et al. Functional outcomes following displaced talar neck fractures. J Orthop Trauma. May-Jun 2004; 18(5): 265-270.
- - Dumont C et al. What are the clinical results of operated fractures of talus ? Z orthop Unfall. 2007 Mars-April ; 145(2) : 212-20.
- - Early JS. Foot fractures and dislocations. In: Rockwood and Green’s. Fractures in adults, 5th ed. Philadelphia: Lippincott Williams and Wilkins, 2005: 383-392.
- - Elgafy H et al. Fractures of the talus: Experience of two level1 trauma centers. Foot Ankle Int. 2000 Dec ; 21(12) : 1023-9.
- - Eric B L, Lindvall E et al. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004; 86: 2229-2234.
- - Fortin PT et al. Talus fractures: Evaluation and treatment. J Am Acad Orthop Surg Mar-Apr 2001; 9(2): 114-27.
- - G. Curvale et al. Pathologie du talus.Cahiers d’enseignement SOFCOT 1999; 70: 87-101.
- - Garcia R et al. Talar neck fractures results and complications by type. Foot and Ankle Surgery 2002; 8: 203-208.
- - Grob D et al. Operative treatment of displaced talus fractures. Clin Orth and Related Rech Oct 1985. 199: 88-96.
- -Hawkins L: Fracture of the talus. J Bone Joint Surg 1970; 52A: 991-1002
- - Heather A et al. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003; 85: 1716-1724.
- - Heather A et al. Talar neck fractures: Results and outcomes. J Bones Joint Surg Am. 2004; 86: 1616-1624.
- - Kubo T et al. Predictive value of Magnetic Resonance Imaging in avascular necrosis following talar fractures. J Orthop Surg. 2000; 8(1): 73-78.
- - Kundel k, Braun W et al. Late results of central talus injuries.Unfallchirurg.1995 Mars; 98(3) : 124-9.
- - Lutz M. Golser K. et al. Post traumatic ischemia of the talus: is talus necrosis unvoidable? Unfallchirurg. 1998; 101:461-7.
- - Nabil A et al. Clinical outcome of fractures of the talar body. Int Orthop (SICOT) 2007; S00264-007-0399-5.
- - Schulze W, Richter J et al. Prognostic factors for avascular necrosis following talar fractures. Z orthop Ihre Grenzgeb. 2002 Jul-Aug ; 140(4) : 428-34.
- - Tehranzadeh J et al. Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 2003 Dec ; 181(6): 1559-63.
- - Tezwal M et al. Prognostic reliability of the Hawkins sign in fractures of the talus. J orthop trauma. Sep 2007; 21(8):538-43.
- - Thomas H et al. Long term results of displaced talar neck fractures. Clin Orthop and Related Res. Oct 1985; 199: 81-87.
- - Weber BG et al. Bruche von knocheln und talus. Bewahrtes und neues in diagnostik und therapie. Langenbecks. Arch chir. 1981; 355: 421-5.
- - Wito S, Jens Richter et al. Surgical treatment of talus fractures. A retrospective study of 80 cases followed for 1-15 years. Acta Orthop Scand. 2002; 73(3): 344-351.
- - Zwipp H, Stefan Rammelt. Talar neck and body fratures. Injury. Apr 2008; 23: 01- 021.
- - Zitaoka HB, Alexander IJ et al. Clinical rating systems for the Ankle-Hindfoot, Midfoot, Hallux and lesser Toes. Foot Ankle Int. 1994; 15(7): 349-53.
- - Z Adelaor S et al. The treatment of complex fracture of the talus. Clin Orthop North Am. 1989; 20: 691-707.
References
-Adel El Sayed. Les fractures de l’astragale.Thèse de médecine, UCAD.N°5 1984.
- Besch L et al. Treatment of rare talus dislocation fractures. An analysis of 23 injuries. Unfallchirurg. 2002 Jul ; 105(7) : 595-601.
- Bonnomet F et al. Chirurgie des fractures du talus.Encycl Med Chir, Techniques chirurgicales, orthopédie-traumatologie. 1995: 44-885
- Coltart WD et al. Aviator’s astragalus. J Bone Joint Surg Br. 1952; 34: 545-566.
- David W, Sanders et al. Functional outcomes following displaced talar neck fractures. J Orthop Trauma. May-Jun 2004; 18(5): 265-270.
- Dumont C et al. What are the clinical results of operated fractures of talus ? Z orthop Unfall. 2007 Mars-April ; 145(2) : 212-20.
- Early JS. Foot fractures and dislocations. In: Rockwood and Green’s. Fractures in adults, 5th ed. Philadelphia: Lippincott Williams and Wilkins, 2005: 383-392.
- Elgafy H et al. Fractures of the talus: Experience of two level1 trauma centers. Foot Ankle Int. 2000 Dec ; 21(12) : 1023-9.
- Eric B L, Lindvall E et al. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004; 86: 2229-2234.
- Fortin PT et al. Talus fractures: Evaluation and treatment. J Am Acad Orthop Surg Mar-Apr 2001; 9(2): 114-27.
- G. Curvale et al. Pathologie du talus.Cahiers d’enseignement SOFCOT 1999; 70: 87-101.
- Garcia R et al. Talar neck fractures results and complications by type. Foot and Ankle Surgery 2002; 8: 203-208.
- Grob D et al. Operative treatment of displaced talus fractures. Clin Orth and Related Rech Oct 1985. 199: 88-96.
-Hawkins L: Fracture of the talus. J Bone Joint Surg 1970; 52A: 991-1002
- Heather A et al. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003; 85: 1716-1724.
- Heather A et al. Talar neck fractures: Results and outcomes. J Bones Joint Surg Am. 2004; 86: 1616-1624.
- Kubo T et al. Predictive value of Magnetic Resonance Imaging in avascular necrosis following talar fractures. J Orthop Surg. 2000; 8(1): 73-78.
- Kundel k, Braun W et al. Late results of central talus injuries.Unfallchirurg.1995 Mars; 98(3) : 124-9.
- Lutz M. Golser K. et al. Post traumatic ischemia of the talus: is talus necrosis unvoidable? Unfallchirurg. 1998; 101:461-7.
- Nabil A et al. Clinical outcome of fractures of the talar body. Int Orthop (SICOT) 2007; S00264-007-0399-5.
- Schulze W, Richter J et al. Prognostic factors for avascular necrosis following talar fractures. Z orthop Ihre Grenzgeb. 2002 Jul-Aug ; 140(4) : 428-34.
- Tehranzadeh J et al. Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 2003 Dec ; 181(6): 1559-63.
- Tezwal M et al. Prognostic reliability of the Hawkins sign in fractures of the talus. J orthop trauma. Sep 2007; 21(8):538-43.
- Thomas H et al. Long term results of displaced talar neck fractures. Clin Orthop and Related Res. Oct 1985; 199: 81-87.
- Weber BG et al. Bruche von knocheln und talus. Bewahrtes und neues in diagnostik und therapie. Langenbecks. Arch chir. 1981; 355: 421-5.
- Wito S, Jens Richter et al. Surgical treatment of talus fractures. A retrospective study of 80 cases followed for 1-15 years. Acta Orthop Scand. 2002; 73(3): 344-351.
- Zwipp H, Stefan Rammelt. Talar neck and body fratures. Injury. Apr 2008; 23: 01- 021.
- Zitaoka HB, Alexander IJ et al. Clinical rating systems for the Ankle-Hindfoot, Midfoot, Hallux and lesser Toes. Foot Ankle Int. 1994; 15(7): 349-53.
- Z Adelaor S et al. The treatment of complex fracture of the talus. Clin Orthop North Am. 1989; 20: 691-707.