2 A Retrospective Analysis of the Definitive Management of Open Talus Fractures at a Major Trauma Centre and an Audit of BOAST 4 Guidelines. (19th August 2022)

• Record Type: Journal Article
• Authors: Zhou, A; Jou, E; Bhatti, F; Patel, R; Zhang, J; Lu, V; Krkovic, M
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.445
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Currently, the management of open talus fractures is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. This retrospective analysis aims to clarify the debate between ORIF and tibiocalcaneal fusion (FUSION). A review of open talus fractures from 2014–2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score ( P = 0.13), FAAM-ADL ( P = 0.20), FAAM-Sport ( P = 0.34), infection rate ( P = 0.55), surgical times ( P = 0.91) and time to weight bearing ( P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.