Ballistic talus fractures: a retrospective analysis

Introduction: Ballistic talus fractures are difficult to treat and there is a paucity of literature regarding the subject. The goal of the current study is to outline our experience and epidemiological findings from a single center with a large case series of ballistic talus fractures.

Materials and methods: Institutional Review Board approval was obtained for a retrospective review of skeletally mature patients with ballistic talus fractures from August 2019 to June 2023. Fracture morphology of the talus, the presence of displacement, and the talar declination angle (TDA) were all characterized. Demographic variables were obtained. All complications were recorded.

Results: 21 tali were included in this cohort (average age = 26, SD = 9.5). 11 (52%) talus fractures were displaced at initial injury and 17 (81%) had additional fractures of the ipsilateral foot and ankle. 29% (6/21) of tali were treated operatively with fixation: 2 talar body, 2 talar neck, and 2 talar head. TDA improved in patients treated operatively (21.8° pre-operatively, 19.6° post-operatively) but not in those treated non-operatively (24.5° pre-operatively, 25.5° at final follow-up). The overall complication rate was 29% (6/21) including 2 minor complications (superficial wound dehiscence) and 4 major complications: 3 patients with early signs of avascular necrosis (AVN)/collapse and 1 infected non-union. Although we had 3 patients with signs of AVN, one of which was converted to an ankle fusion, all patients were sucessfully treated with limb salvage.

Conclusions: The current study offers a unique and previously unreported cohort of gunshot related talar fractures. Our deep infection rate of 4.8% was similar to other studies of closed talus fractures. We found an improvement in the average TDA for the operatively treated fractures, which may represent improvements in fracture reduction with operative fixation. Further studies with longer follow-up are necessary improve our limited understanding of these injuries and to enhance treatment.