[Peripherial talar fractures]

M Richter
Operative Orthopädie und Traumatologie 2013, 25 (6): 542-53

OBJECTIVE: Open reduction and internal fixation with screw(s) for fragments with sufficient size, and resection of smaller fragments.

INDICATIONS: Displaced fragments with (typical) involvement of joint surface.

CONTRAINDICATIONS: Active infection and severe peripherial vascular disease.

SURGICAL TECHNIQUE: Positioning and approach are adapted to the fracture location. Fractures of the talar head and talar shoulders, supine position and anteromedial/-lateral approach. Fractures of the lateral talar process, lateral position on contralateral side and lateral approach. Fractures of the posterior talar process, prone position and posterolateral approach. Fractures of the medial, supine position and medial approach. Open reduction and internal screw fixation. Cartilage-surgical procedures for concomitant chondral defects.

POSTOPERATIVE MANAGEMENT: For the first 6 weeks, 15 kg partial weight bearing without orthosis in a standard shoe. Thrombosis prophylaxis following the local standard during the time of partial weight bearing.

RESULTS: At a specialized orthopedic hospital with a supraregional frequented department for foot and ankle surgery, 8 patients with peripherial talar fractures were treated in 2012 (medial/posterior talar process, each n = 1, lateral talar process, n = 2, medial and lateral talar shoulder, each n = 2). One fragment was fixed with 1-3 screws, and additional cartilage reconstruction with matrix-associated stem cell transplantation was performed in 4 cases (lateral talar process, n = 2, medial and lateral talar shoulder, each n = 1). Bony fusion was registered at the 6-week follow-up in all cases. Further follow-up is not completed. Complications have not been registered so far.

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