Talar Neck Fractures and Their Associated Risk Factors of Avascular Necrosis: A Prediction Model

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Talar neck fractures account for 1% of foot and ankle fractures and are often associated with poor outcomes and high morbidity rates. Predicting talar neck fracture complications is crucial for informing patients about potential complication rates and determining the optimal treatment options, follow-up period, and frequency. The primary risk factor for talar neck fractures progressing into AVN is the Hawkins Classification. As the severity of the fracture and dislocations, so does the risk of AVN. The primary aim of this study is to identify the risk factors associated with talus AVN after surgically treated talar neck fractures. Methods: We performed a retrospective chart review of all patients with talar neck fractures who were surgically treated at 3 trauma centers from 2018 to 2023, which revealed 167 patients. Patients who had a talar neck fracture operated with open reduction and internal fixation are included. Talar neck fractures and AVN were classified according to their x-rays and computed tomography images after injury. Results: The logistic regression model revealed that Hawkins Classification was a strong predictor of AVN development. Compared to Type I fractures, Type II fractures had an odds ratio (OR) of 2.67 (95% confidence interval [CI]: 1.02–6.99, p = 0.045), Type III fractures had an OR of 4.53 (95% CI: 1.64–12.47, p = 0.004), and Type IV fractures had a markedly increased OR of 37.43 (95% CI: 6.80–206.08, p < 0.001). Patients who consumed alcohol had a higher likelihood of developing AVN (OR = 2.65, 95% CI: 1.22–5.76, p = 0.014). Additionally, diabetic patients were more likely to develop AVN compared to non-diabetic patients (OR = 3.14, 95% CI: 1.04–9.45, p = 0.042). Conclusion: Hawkins classification was a strong predictor for talar avascular necrosis with type IV fractures having a markedly higher odds ratio compared to type I fractures. Talar avascular necrosis had a higher incidence in diabetic patients compared to non-diabetic patients as well as patients who consumed alcohol. Non – significant predictors included fracture type, age, and smoking status. These findings suggest that Hawkins classification, diabetes, and alcohol consumption may be risk factors for talar AVN.