Comparison between percutaneous and open reduction for treating paediatric talar neck fractures.

BACKGROUND: The purpose of the study was to introduce percutaneous reduction and fixation of paediatric talar neck fractures. The study also included a comparison between the technique and the conventional open surgery.

METHODS: From October 2003 to May 2013, 23 children (group A) with closed two-part talar neck fractures were treated with percutaneous reduction. For comparison, another group of 26 children (group B) were treated with the conventional open surgery. A p value < 0.05 was considered statistically significant.

RESULTS: In group A, bone healing was achieved in all cases at a mean of eight weeks. At the mean follow-up of 27 months, mean plantar flexion and dorsiflexion reached 96% of the opposite, normal, side. There were 20 excellent and three good results. In group B, bone healing occurred in 21 of 26 cases at a mean of 11 weeks. Nonunion was noted in five patients, among whom three were combined with avascular necrosis of the talar body. Mean follow-up was 29 months; mean plantar flexion and dorsiflexion reached 94% of the opposite normal side. There were 13 excellent, six good, two fair and five unsatisfactorily results. There were significant differences in the time to bone healing and in ankle-joint motion and function (p < 0.05).

CONCLUSIONS: Percutaneous reduction is a successful technique for paediatric talar neck fractures. Compared with conventional open surgery, the mini-invasive procedure may produce rapid bone healing and better functional results.

LEVEL OF EVIDENCE: Therapeutic study, Level Ia (perspective study).