[Minimally invasive osteosynthesis. : even in talus fractures?]

M Tezval, S Schmoz, C Dumont
Operative Orthopädie und Traumatologie 2012, 24 (4-5): 396-402

OBJECTIVE: Minimally invasive osteosynthesis of talar fractures.

INDICATIONS: Minimally displaced fractures of the lateral process of the talus and talar neck fractures type 1 according to Hawkins classification.

CONTRAINDICATIONS: Dislocated peripheral fractures. Displaced fractures of the talar neck or body.

SURGICAL TECHNIQUE: For factures of the lateral process of the talus: short incision of skin over the lateral process of the talus. Gentle preparation and contact with the bone with scissors. Fragment reposition using a dentist's hook and Kirschner wire in a joy-stick technique under C-arm imaging. Stabilization with a miniscrew. For talar neck fracture Hawkins type 1: short incision of skin ventromedially and ventrolaterally. Blunt preparation of soft tissue and safe bone contact. Introduction of one small-fragment corticalis screw both medially and laterally under C-arm imaging. As an alternative, cannulated screws can also be used.

POSTOPERATIVE MANAGEMENT: For fractures of the lateral process of the talus: postoperative protection in an ankle splint (air cast, gel cast) for 4 weeks. During this time moderate weight bearing is possible. For talar neck fractures Hawkins type 1: physiotherapy and only floor contact for 6 weeks.

RESULTS: From January 1996 to December 2002, 44 talar fractures were operatively treated in our department. Six patients had talar neck fractures type 1 according the Hawkins classification and 3 patients showed fractures of the lateral process of the talus. From those injuries, 3 Hawkins type 1 fractures and 2 fractures of the lateral process were stabilized using minimally invasive osteosynthesis. The clinical outcomes were assessed using the Ankle Hindfoot Scale of the American Orthopedic Foot and Ankle Society. Both groups reached good cosmetic and functional results. We did not observe any avascular talar necrosis or nonunions in the two groups.

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