Aktuelle Therapieempfehlungen bei Talusluxationsfrakturen vom Typ IV nach Marti und Weber – ein Literaturreview

Abstract

Introduction Talar dislocation fractures of type IV (Marti and Weber) are extremely rare injuries with special challenges to the surgeon and poor results. Due to their low incidence and the sparse literature, it is unclear what is the optimal treatment and how complications can be minimised. Material and Methods A literature research was carried out using the online medical database "PubMed". The findings of the literature were then applied to a clinical case of type IV talar dislocation fracture (Marti and Weber). Results Modern osteosynthesis with generous and multiple access paths is to be preferred to the previously prioritised methods of talectomy and arthrodesis. Priority is put on the fastest possible reposition of the fracture, while sparing the soft tissue and the conditions of vascularisation. It can be assumed that with increasing degree of dislocation the risk of necrosis of the talus rises too, but this does not necessarily correlate with the clinical outcome. Conclusions In totally dislocated fractures of the talus, the focus is on prompt reposition and sufficient osteosynthetic supply. Nevertheless, frequent complications have to be expected. Medial explantation, which is described in the clinical example and lateral re-implantation of the talar body have never been described before in the literature and were an encouraging development.