Infection Rates and Surgical Procedures Associated With Isolated Open Talar Neck and Body Fractures

Abstract

Background: Open fractures of the talar body and neck are uncommon. Previous reports of associated deep infection rates and resulting surgical requirements vary widely. The primary objective of this study is to report the incidence of deep infections for isolated open talar body and neck fractures, and secondarily the incidence and number of total surgeries performed (TSP), secondary salvage procedures (SSPs), and nonsalvage procedures (NSPs). Methods: Retrospective case-control study of 32 consecutive isolated open talus fracture patients (22 neck, 10 body) were followed for an average of 39.2 months. Results: Five (15.6%) fractures developed deep infections. Fifty percent of open body fractures became infected compared with 0% of neck fractures ( P < .001). There was no difference between infected group (IG) and uninfected fracture group (UG) with respect to age, sex, body mass index, tobacco, diabetes, vascular disease, open fracture type, wound location, hours to irrigation and debridement, or definitive treatment. The majority (92.6%) of UG fractures used a dual incision with open wound extension. There were more single extensile approaches in the IG group ( P = .04). The IG required 5.8 TSP per patient compared with 2.1 in the UG ( P = .004). All (100%) of the IG required an SSP compared with 29.6% of the UG ( P = .006). All (100%) of the IG required an NSP compared to 40.7% of the UG ( P = .043). In the IG, 2.8 NSPs per patient were required after definitive surgery compared with 1.18 in the UG ( P = .003). Of those followed 1 year, the incidence of SSP remained higher in the IG ( P = .016). Conclusion: The incidence of deep infection following isolated open talar fractures is high and occurs disproportionally in body fractures. Infected fractures required nearly 6 surgeries, and all required SSP. Level of Evidence: Level IV, prognostic.