Tibial Nerve Dysfunction Associated With Operatively Treated Talar Neck Fractures

Objective: To investigate the presence of tibial nerve dysfunction (TND) in operatively treated talar neck fractures. Design: Retrospective chart review. Setting: Urban Level-1 trauma center. Patients: Sixty-four patients for a total of 65 talar neck fractures treated with open reduction and internal fixation between January 1, 2014, and May 1, 2018. Main Outcome Measures: Incidence of TND. Results: Evidence of TND was documented in 20 of 65 cases (30.8%) of talar neck fractures. There were no cases of TND associated with Hawkins I fractures, but TND was found in 7 of 32 Hawkins II fractures (21.9%), 10 of 24 Hawkins III fractures (41.7%), and 3 of 5 Hawkins IV fractures (60%). TND was reported in 11 of 19 open talar neck fractures (57.9%) (P= 0.002). TND was associated with tibiotalar dislocation (P= 0.017) but not subtalar dislocation (P= 0.17). TND did not occur in the absence of subtalar subluxation/dislocation. Of 18, a total of 6 (33.3%) reported partial recovery, and 6 (33.3%) reported full recovery within 6 months of the initial injury. By 12 months, of the 18, 8 (44.4%) reported partial recovery and 7 (38.9%) reported full recovery. Conclusion: The tibial nerve and its distal branches are at risk of injury in the setting of displaced talar neck fracture, tibiotalar subluxation/dislocation, and open talar neck fracture with increasing risk among those with a higher Hawkins grade.