Arch-shaped approach : New modified medial approach for the treatment of talus fractures

Abstract

Anatomical reduction and fixation of complex talar fractures (Hawkins typeIII andIV, Marti typeIII andIV) using amedial approach. Displaced talar fractures (Hawkins typeIII andIV, Marti typeIII andIV) with the need for amedial malleolar osteotomy or the simultaneous treatment of amedial malleolus fracture. High perioperative risk, severe soft tissue injuries in the medial approach area, infected soft tissues. Medial arch-shaped approach about 12 cm in length over the medial malleolus using asimultaneous medial malleolus fracture or via an additional medial malleolar osteotomy. Dissection and retraction of the terminal branches of the saphenous vein and the saphenous nerve. Protection of the blood supply in the area of the medial talus and in the sinus tarsi. Reduction of the talar joint surfaces and reconstruction of the anatomical axes according to the preoperative planning by means of native radiological and computed tomographic imaging. Osteosynthesis adapted to the fracture type using Kirschner wires, conventional screws, cannulated screws, double-threaded screws, resorbable pins, magnesium screws, small fragment plates. Lower leg splint or orthesis for 6weeks, partial weight-bearing with 20 kg for 10-12weeks. Early range of motion exercise of the ankle, subtalar and mid-tarsal joints. In the past 5years, 11patients with either Hawkins typeIII andIV or Marti typeIII andIV fractures were treated operatively using the arch-shaped approach. No soft tissue problems were seen related to the arch-shaped approach. Of the 7patients who could be followed up after an average of 2years, the mean American Orthopedic Foot and Ankle Score was73. Avascular necrosis occurred in 3cases (43%). These were partial necroses of less than one third of the talar body with asymptomatic course at the time of examination. In 4patients (57%) radiographic signs of osteoarthritis occurred within 2years, whereby in two of those cases (29%) an arthrodesis of the upper ankle was performed.