What is the rate and timing of salvage surgery after operative treatment of talus fractures?

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2025-03-14 DOI:10.1097/BOT.0000000000002975

Erika Roddy, William Hannay, Bilal Khilfeh, Kira Newell, David Dalstrom, Bruce Sangeorzan, Stephen Benirschke, Reza Firoozabadi

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引用次数: 0

Abstract

Objectives: To report on the short-term, mid-term, and long-term rates of salvage treatment after operative treatment of talus fractures.

Design: Retrospective cohort study.

Setting: Level one trauma center.

Patient selection criteria: All patients with a talus fracture (AO/OTA 81.1-81.3) treated surgically at a level one trauma center between 2008 and 2018 were eligible for inclusion.

Outcome measures and comparisons: The primary outcome was conversion to salvage treatment, defined as conversion to arthroplasty, arthrodesis, or amputation.

Results: A total of 343 patients with operatively treated talus fractures were identified. One hundred and twenty eight patients were reached by telephone for long-term follow-up. Two hundred and twenty two (65%) were men. The mean age was 35 (SD 10, range 14-70). There were 195 (57%) talar neck fractures, 113 talar body fractures, 5 talar head fractures, and 30 lateral process fractures. The mean duration of follow-up was 5 years. Twenty-four patients (7%) underwent 24 salvage procedures. The rate of salvage was 1% (95% CI 0-3%) at 1 year, 3% (95% CI 1-6%) at 2 years, 10% (95% CI 6-15%) at 5 years, 13% (95% 9-20%) at 10 years, and 15% (10-22%) at 16 years. All salvage procedures occurred within 11 years, and 80% occurred within 5 years of injury. In multivariate cox analysis, the presence of higher Hawkins type as well as the presence of AVN with collapse (HR 4.67 (95% CI 1.82, 11.99, p=0.001)) and arthritis (HR 5.70 (95% CI 1.25, 25.78, p=0.024) remained predictive of conversion to salvage treatment.

Conclusions: The rate of salvage surgery was 15% at 16 years after operative treatment of talus fractures. The highest risk of conversion to salvage treatment was within the first 5 years. The presence of a neck or body fracture, higher Hawkins classification, development of AVN with collapse, and arthritis were associated with increased risk of conversion to salvage treatment.

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距骨骨折手术治疗后进行抢救性手术的比例和时机是什么？

目的：报道距骨骨折手术治疗后的短期、中期和长期抢救率。设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：所有2008年至2018年间在一级创伤中心接受手术治疗的距骨骨折（AO/OTA 81.1-81.3）患者均符合入选条件。结果测量和比较：主要结果是转为挽救性治疗，定义为转为关节置换术、关节融合术或截肢。结果：手术治疗距骨骨折343例。通过电话对128名患者进行了长期随访。222人（65%）是男性。平均年龄35岁（SD 10，范围14-70）。距骨颈骨折195例（57%），距骨体骨折113例，距骨头骨折5例，距骨外侧突骨折30例。平均随访时间为5年。24例患者（7%）接受了24次抢救手术。1年抢救率为1% (95% CI 0-3%)， 2年抢救率为3% (95% CI 1-6%)， 5年抢救率为10% (95% CI 6-15%)， 10年抢救率为13%(95% 9-20%)，16年抢救率为15%（10-22%）。所有救助发生在11年内，80%发生在5年内。在多变量cox分析中，存在较高的Hawkins型以及AVN合并塌陷(风险比4.67 （95% CI 1.82, 11.99, p=0.001）和关节炎(风险比5.70 （95% CI 1.25, 25.78, p=0.024）仍然预示着转行抢救治疗。结论：距骨骨折术后16年抢救手术率为15%。转为救助治疗的最高风险发生在前5年内。颈部或身体骨折、Hawkins分级较高、AVN伴塌陷和关节炎的发生与转向抢救治疗的风险增加相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.