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CASE REPORT
Osteochondral Fracture of the Talar Dome in 21M
https://upload.orthobullets.com/cases/102731/ab-a1.jpg https://upload.orthobullets.com/cases/102731/ab-a2.jpg
A
Adam Bitterman DO
Northwell Health Physician Partners Orthopaedic Institute at Huntington
John Grossi DO
Orthopaedic Surgeon - General Specialty
Johann Braithwaite DO
Northwell Health
Northwell Health
Northwell Health
VIEW EXPERT OPINIONS
HPI
A 21-year-old male presents to the clinic with a chief complaint of an acute left ankle injury one week prior to presentation. He reports a fall on hi... s motorcycle where the motorcycle fell on top of his left ankle, followed by immediate pain and swelling. He was evaluated and splinted in the ER, where x-rays demonstrated a displaced fracture of the lateral talar dome, and he was discharged for outpatient follow-up. He presents to the clinic with crutches, non-weightbearing in a splint.
3643   votes
4
(P: 217108) If you choose fragment reduction & fixation, how would you perform your procedure?
I would not choose operative management with fragment fixation
1%
6/316
Open
46%
148/316
Arthroscopic
16%
51/316
Combined Open and Arthroscopic
31%
98/316
Outside my area of expertise - best if I don't vote
4%
13/316
5   Surgeons
1
Brock Browning, DO Cape Fear Orthopedics & Sports Medicine, US
TOP 5 %
Learning
United States of America
Last Week
United States of America
2
mohamed fouad, MD alexandria, EG
TOP 5 %
Patient Care
Egypt
Last Week
Egypt
3
Harry Steinman, MD Veracity-Benefits
TOP 5 %
Patient Care
United States of America
Last Year
United States of America
4
George Magarakis, MD Heraklion, GR
TOP 5 %
Patient Care
Greece
Last Week
Greece
5
Rodrigo Corena, MD QuironSalud Malaga
TOP 5 %
Patient Care
Spain
Last Month
Spain
60   Countries
Leaflet
1
United States of America
84 surgeons
2
India
16 surgeons
3
Greece
14 surgeons
4
Spain
11 surgeons
5
United Kingdom of Great Britain and Northern Ireland
9 surgeons
116   Expert Comments
Anas Malkawi MD
TOP 5 %
Patient Care
Germany
Last Week
flake fracture are typically associated with high-energy trauma and associated injuries are not uncommon especially ligament injuries like deltoid especially with increased talar tilt as seen on these x rays
Adam Bitterman DO
TOP 5 %
Patient Care
United States of America
Last Year
postop was NWB for 4 weeks. boot at 2 weeks and progressive range of motion. Fixation was rock solid.
Naji MADI MD
TOP 5 %
Patient Care
United States of America
Last Year
Jan Szatkowski, MD, MBA looks great. Well planned and executed. Key to notice in the intraop X-ray the 2 wires placed in the fragment by Dr. Adam Bitterman - even when the fragment is too small for 2 screws, an additional wire help avoid fragment malreduction/rotation when placing the screw in. Be... autiful outcome!
Michael Campbell MD
TOP 5 %
Patient Care
United States of America
Last Year
Acute injury and I'll educate, lay the crepe, and fix. Revision, no way. I give them the "definition of insanity" line. In all seriousness, I had 2 patients successfully quit smoking using hypnosis 🫣
Nicholas Frane DO
TOP 5 %
Patient Care
United States of America
Last Year
The bone anatomy is what I would be looking for here. Figure out orientation and more details in the dome fragment. I am not sure what MR would add
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Clubfoot (congenital talipes equinovarus)
PMID: 1548277 J Bone Joint Surg Am. 1992 Mar;74(3):448-54.
D
2
post

Treatment of congenital club foot.

I V Ponseti
Treatment of congenital club foot.
Pubmed
Journal



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On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
73% Article relates to my practice (11/15)
20% Article does not relate to my practice (3/15)
6% Undecided (1/15)
7   Countries
Leaflet
TOP     EXPERTS
1
Anastasios Pitsounis, MD Athens, GR
TOP 5 %
Patient Care
Greece
Last Week
Greece
2
Nabeel Salem alarby, DO Aden, YE
TOP 5 %
Patient Care
Yemen
Last Year
Yemen
3
Abdulrahman Shahout, MD Misurata, LY
Libya

Will this article lead to more cost-effective healthcare?

86% Yes (13/15)
6% No (1/15)
6% Undecided (1/15)

Was this article biased? (commercial or personal)

6% Yes (1/15)
86% No (13/15)
6% Undecided (1/15)

What level of evidence do you think this article is?

6% Level 1 (1/15)
13% Level 2 (2/15)
26% Level 3 (4/15)
20% Level 4 (3/15)
33% Level 5 (5/15)
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    Treatment of congenital club foot.
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