5 months ago I had a displaced talar neck fx. I'm still waiting to see if AVN develops, but my OS tells me the chances are high. He recommends an ankle fusion, but I'm 26, rock climb, snowboard and run, and cannot imagine life without these activities. I read a little on core decompression, but am having trouble finding more details. I'm willing to try ANYTHING to save my ankle function, can someone tell me what alternatives there are, and how long it will be before I know if AVN has set in?

thanks!

-- clara soh (clara@nyu.edu), February 25, 2004

Answers

10 months ago I also had a displaced talar meck fracture. From the literature I have read, developing AVN depends greatly on how much the displacment was (or what type of frature, type I, II, III, or IV). I don't know how much mine dislocated, but around the 6th or 7th month the Dr. decided that there was a little bit of AVN happening. Then at the 8th month he preformed core decompression. In core decompression (or atleast in mine), they drilled several tiny holes through the good bone into the dead bone. Then they filled the holes up with my blood. The idea being that the dead bone is dead becuase it has no blood and can't fix itself becuase it still has no blood and nothing to fix itself with. So when it gets the new blood from the core decompression, it now has all the parts it needs to fix itself. After 6 weeks they took an MRI and a CT scan and told me I could start to put weight on it. But after 10 months that is no peice of cake either. But I definatly feel for you at not wanting to have your ankle fused being a runner and rock climber myself. There is core decompression and a vascularized bone graph that can be done. I guess basically just stay off it until you know if there is AVN for sure. But in the meantime, you can go one legged top-ropping. Just have a really good belayer. Sure your style goes out the window, but everyone who sees you is thinking "wow, now she is hard

-- maya stevens (mstevens@calpoly.edu), February 26, 2004.

Unfortunately, talar neck fractures are prone to development of AVN. The more displaced they are following an injury, the higher the chances of AVN. Plain radiographs, and sometimes MRI, are utilized to make the diagnosis/prognosis. Core decompression in this setting has not been well described, as far as I know - although outcomes are well documented following AVN for other reasons. If you develop AVN - and it is symptomatic - it may be worth a try.

-- Mesfin Lemma, M.D. (mlemma2@jhmi.edu), March 01, 2004.