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• Talus fractures are anatomically complex injuries associated with poor outcomes and high complication rates. • This was a large series of talus fractures. Overall AVN rate was 6% and non-union rate was 2%. The postoperative infection rate was 4%. • AVN and malunion often cause chronic pain, difficulties in performing activities of daily living and decreased mobility. • Our study found talar body fractures are more common than previously reported, talar neck fractures still cause the greatest rates of AVN and post-traumatic arthritis. • This information is useful during consenting and preoperatively when planning these cases to ensure these outcomes are prevented. Talus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. We retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. The mean age was 35 years (range: 18–76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. Our study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated. [ABSTRACT FROM AUTHOR]

Introduction: Calcaneal fractures are rare in children. These fractures are often misdiagnosed as a consequence of their subtle clinical and radiographic presentation. The purpose of this paper was to identify prognostic factors on the basis of type of fracture, age and treatment. This would enable suggestions to be made with regards to treatment for these fractures.Methods: A full literature search was performed to find studies that were clinically orientated, in the English language and involved children (under the age of 16). Studies with no outcome data were excluded.Results: There were a total of 284 patients reviewed in 26 peer-review publications. Two hundred and eight patients had intra-articular fractures. The non-operatively managed joint depression type fractures had poor outcomes in 21% of patients. In those who underwent surgical fixation for these fractures, 3 patients had reduced subtalar motion, and three had pain, one of whom required a subtalar arthrodesis at 7 months. In the tongue type fracture group, the outcomes were similar in those treated operatively and non-operatively. Extra-articular fractures were found to be much less common than the intra-articular fractures. They also became less common in older children. Generally, the outcomes were good, irrespective of treatment. Only 2 patients with type 1B fractures had poorer outcomes.Discussion: This is a rare injury and outcomes may be poorer in those who do not have adequate anatomical reduction. Displaced intra-articular fractures in all age groups should be considered for anatomical reduction of the articular surface, to guarantee good outcomes and prevent future pain and arthritis. Extra-articular fractures in children are less severe, do well with conservative treatment, and rarely require operative intervention. [ABSTRACT FROM AUTHOR]