OTA 2005 Posters

Scientific Poster #86 Foot & Ankle

Posteromedial Talar Body Fractures: Surgical Technique and Outcome in Ten Patients

Michael P. Swords, DO, Stephen K. Benirschke, MD, John R. Shank, MD, Justin Greisberg, MD (n-all authors);

Harborview Medical Center, University of Washington,

Seattle, Washington, USA

Purpose: Posteromedial talus fractures are uncommon injuries and a challenge to treat. A posteromedial surgical approach with rigid internal fixation is described, and the results of 10 cases treated with this technique are reported.

Methods: 10 patients with posteromedial talus fractures a minimum of 1 year following injury were identified from a trauma database. All injuries were diagnosed acutely. Mechanism of injury, association with subtalar dislocation, time to operative fixation, and concomitant foot and ankle injuries were recorded. All patients were treated surgically by a posteromedial surgical approach. Surgical complications were recorded. Patients completed a Musculoskeletal Functional Assessment to measure functional outcomes.

Results: Mean age was 34.8 years. Follow-up ranged from 1 to 10 years (mean 4.5 years). 5 injuries were a result of motor vehicle accidents, 3 from falls, 1 from a crushing injury, and 1 was a simple tripping injury. 6 of 10 patients had subtalar dislocations at time of presentation, 2 did not have dislocation, and it was undocumented in 2 patients. Two subtalar dislocations were open injuries. Six patients had other musculoskeletal injuries. Four patients had other injuries to the foot and ankle. Average time to operative fixation was 8.5 days. All patients were treated with operative fixation by a posteromedial approach. Fixation was achieved with 2.0-mm plates and screws. Two patients had parasthesias in the medial calcaneal nerve distribution postoperatively; one resolved. No patients have required arthrodesis. MFA collection is in progress.

Discussion: This is a large series of this rare and challenging type of talus fracture. Giuffrida et al previously reported a series of six cases in which diagnosis was delayed and arthrodesis was required in five. Outcomes were generally poor. This series demonstrates that with prompt diagnosis and appropriately timed open reduction internal fixation by a posteromedial approach and rigid internal fixation, good results and low arthrodesis rates can be obtained.

Significance: Posteromedial talus fractures are rare injuries. This series describes a surgical technique and fixation for this fracture. Using this technique, we achieved good operative results and had no cases of arthrodesis.