Demographics, mechanism of injury, and associated injuries of 25,615 patients with talus fractures in the National Trauma Data Bank

Nidharshan S Anandasivam; Paul Bagi; Nathaniel T Ondeck; Anoop R Galivanche; Lovemore S Kuzomunhu; Andre M Samuel; Daniel D Bohl; Jonathan N Grauer

doi:10.1016/j.jcot.2019.06.007

Demographics, mechanism of injury, and associated injuries of 25,615 patients with talus fractures in the National Trauma Data Bank

J Clin Orthop Trauma. 2020 May-Jun;11(3):426-431. doi: 10.1016/j.jcot.2019.06.007. Epub 2019 Jun 8.

Authors

Nidharshan S Anandasivam¹, Paul Bagi¹, Nathaniel T Ondeck², Anoop R Galivanche¹, Lovemore S Kuzomunhu¹, Andre M Samuel², Daniel D Bohl³, Jonathan N Grauer¹

Affiliations

¹ Yale School of Medicine, Department of Orthopaedics and Rehabilitation, 47 College Street, New Haven, CT, 06510, USA.
² Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70St., New York, NY, 10021, USA.
³ Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St Suite 400, Chicago, IL, 60612, USA.

Abstract

Background: Extensive research has been conducted concerning the epidemiology of fractures of the calcaneus and ankle. However, less work has characterized the population sustaining talus fractures, necessitating the analysis of a large, national sample to assess the presentation of this important injury.

Methods: The current study included adult patients from the 2011 through 2015 National Trauma Data Bank (NTDB) who had talus fractures. Modified Charlson Comorbidity Index (CCI), mechanism of injury (MOI), Injury Severity Score (ISS), and associated injuries were evaluated.

Results: Out of 25,615 talus fracture patients, 15,607 (61%) were males. The age distribution showed a general decline in frequency as age increased after a peak incidence at 21 years of age. As expected, CCI increased as age increased. The mechanism of injury analysis showed a decline in motor vehicle accidents (MVAs) and an increase in falls as age increased. ISS was generally higher for MVAs compared to falls and other injuries.Overall, 89% of patients with a talus fracture had an associated injury. Among associated bony injuries, non-talus lower extremity fractures were common, with ankle fractures (noted in 42.7%) and calcaneus fractures (noted in 27.8%) being the most notable. The most common associated internal organ injuries were lung (noted in 19.0%) and intracranial injuries (noted in 14.9%).

Conclusion: This large cohort of patients with talus fractures defined the demographics of those who sustain this injury and demonstrated ankle and calcaneus fractures to be the most commonly associated injuries. Other associated orthopaedic and non-orthopaedic injuries were also defined. In fact, the incidence of associated lumbar spine fracture was similar to that seen for calcaneus fractures (14%) and nearly 1 in 5 patients had a thoracic organ injury. Clinicians need to maintain a high suspicion for such associated injuries for those who present with talus fractures.

Level of evidence: Level II, retrospective study.

Keywords: Associated injuries; Mechanism of injury; Talus; Talus fracture.

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States