SLR - November 2020 - Conor R. Keeley

Tibial Nerve Dysfunction Associated with Operatively Treated Talar Neck Fractures 

Reference: Huynh T, Staley C, Singer A, Schenker M, Moore T Jr. Tibial Nerve Dysfunction Associated with Operatively Treated Talar Neck Fractures. J Orthop Trauma. 2020 Apr 2. doi: 10.1097/BOT.0000000000001777. Epub ahead of print. PMID: 32251252.

Level of Evidence: Level IV Retrospective Cohort Study

Scientific Literature Review 

Reviewed By: Conor R. Keeley, DPM
Residency Program: University of Florida Health Jacksonville – Jacksonville, FL

Podiatric Relevance: Talar neck fractures are often high energy injuries fraught with multiple complications. The literature mainly focuses on avascular necrosis, malunion, and post-traumatic arthritis, but TND (tibial nerve dysfunction) is another complication that should not be overlooked.

Methods: This is a retrospective cohort study of 65 talar neck fractures in 64 patients at an urban level 1 trauma center between January 2014 and June 2018. Patients were categorized by the ATO/AO classification system as well as the Hawkins modified by Canale and Kelly classification system. TND was defined as hyperesthesia, hypoesthesia, paresthesia, or neuropathic pain affecting the plantar aspect of the foot as documented in any clinical examination. Chi-square analysis was used to determine the association between TND and possible predictive variables: open fractures, comminuted fractures, talus dislocation, associated hindfoot trauma, and medial malleolar osteotomy. The significance threshold was set at 0.05.

Results: 
• Evidence of TND in 20/65 (30.8 percent) 
• 0 percent of Hawkins I 
• 21.9 percent of Hawkins II (7/32)
• 41.7 percent of Hawkins III (10/24)
• 60 percent of Hawkins IV (3/5)
• 57.9 percent of Open Fractures (11/19)
• 9 TND first noted pre-operatively, 11 first noted post-operatively
• 2/20 TND were lost to follow up. At six months post op 6/18 experienced full recovery, 6/18 experienced partial recovery, and 6/18 experienced no recovery. At 12 months post op experienced 8/18 full recovery, 7/18 experienced partial recovery, and 3/18 experienced no recovery
• TND was not associated with concomitant calcaneus fractures, medial mal osteotomies, or comminuted talar neck fractures

Conclusions: Tibial nerve dysfunction is a common complication in talar neck fractures and is correlated with increased energy mechanisms of talar neck fractures, most specifically open fractures and talar dislocation fractures. A thorough neurological exam should be performed pre and post-operatively in order to best evaluate and treat these injuries. Knowledge of the incidence of TND in patients with talar neck fractures will help guide discussions with patients for podiatric physicians who manage these injuries.

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