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Talus fracture with subtalar dislocation 63M
HPI
63-year-old male presenting to the Emergency Department with complaints of right ankle and foot pain after sustaining an injury earlier that day. He reports that he was climbing a ladder, when it slid out from under him causing him to fall approximately 5-feet. He ambulates unassisted at baseline. He reports no other complaints at this time.
PMH
Past medical history is significant only for well-controlled hypertension
PE
He reports tenderness to palpation about the ankle and foot. There is an obvious gross deformity noted. He is able to wiggle all toes. He has a 2+ dorsalis pedis pulse with brisk capillary refill in all toes. He reports sensation to light touch throughout the foot. No open wounds are appreciated.
1.
In addition to the plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
9%
101/1111
Yes - additional radiographs (XR)
0%
6/1111
Yes - CT scan of the foot/ankle (CT)
74%
826/1111
Yes- MRI scan of the foot/ankle (MRI)
2%
23/1111
Yes - XR + CT
9%
104/1111
Yes - XR + MRI
0%
4/1111
Yes - MRI + CT
1%
14/1111
Yes - XR + CT + MRI
1%
14/1111
Outside my area of expertise - best if I don't vote
1%
19/1111
2.
Would you use a classification system for this injury to guide management?`
No - a classification system would not help me
29%
308/1051
Yes - AO/OTA
15%
161/1051
Yes - Hawkins
46%
492/1051
Yes - Other
1%
18/1051
Outside my area of expertise - best if I don't vote
6%
72/1051
3.
How would you defintiively manage this patient?
Nonoperative
1%
19/1059
Operative
96%
1022/1059
Outside my area of expertise - best if I don't vote
1%
18/1059
4.
If you choose Operative management, would you temporize this patient prior to definitive fixation?
I would not choose Operative management
0%
6/1036
No - I would fix this acutely
43%
454/1036
Yes - Splint
30%
314/1036
Yes - External fixation
22%
235/1036
Outside my area of expertise - best if I don't vote
2%
27/1036
5.
If you choose Operative management, what treatment would you plan for and perform?
I would not choose Operative management
0%
1/1027
External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)
1%
12/1027
Closed reduction percutaneous fixation (CRPP) (includes pins and/or screws)
11%
123/1027
Open reduction internal fixation (ORIF) (includes plate, screws, wires, minimally invasive plate)
81%
834/1027
Arthrodesis
2%
22/1027
Outside my area of expertise - best if I don't vote
3%
35/1027
6.
If you choose Open reduction internal fixation (ORIF), which implants would you utilize?
I would not choose ORIF
0%
8/1000
K-wires only
0%
3/1000
Screws only
30%
302/1000
Staples only
0%
3/1000
Screw(s) and K-wire(s)
26%
264/1000
Screw(s) and staple(s)
3%
38/1000
Staple(s) and K-wire(s)
0%
5/1000
Plate and screws
33%
331/1000
Other
0%
1/1000
Outside my area of expertise - best if I don't vote
4%
45/1000
7.
If you choose Open reduction internal fixation (ORIF), what approach would you use?
I would not choose ORIF
0%
7/975
Anteromedial only
13%
136/975
Anterolateral only
6%
61/975
Lateral only
1%
18/975
Posteromedial only
16%
162/975
Posterolateral only
3%
37/975
Dual Incision - Combination of two above approaches
48%
474/975
Three Incision - Combination of three above approaches
1%
10/975
Outside my area of expertise - best if I don't vote
7%
70/975
8.
If you choose ORIF and to include a Posteromedial approach, which interval would you use?
I would not choose to include a posteromedial approach
11%
102/891
Tibialis posterior (TP) tendon subsheath
11%
104/891
Between TP and Flexor digitorum longus (FDL)
27%
247/891
Between FDL and NV bundle
5%
50/891
Between NV bundle and flexor hallicus longus (FHL)
7%
71/891
Between FHL and Achilles tendon
22%
199/891
Outside my area of expertise - best if I don't vote
13%
118/891
9.
If you choose Operative management and attained the construct shown below, what would your postoperative weight-bearing status be?
I would not choose Operative management
0%
1/880
Non-weight-bearing (NWB)
85%
749/880
Partial weight bearing
1%
15/880
Touch-down weight bearing
4%
39/880
Toe-touch weight bearing
4%
40/880
Weight-bearing as tolerated
1%
13/880
Outside my area of expertise - best if I don't vote
2%
23/880
10.
If you choose acute Operative management and attained the construct shown below with NWB postoperatively, how long would you keep the patient NWB?
I would not choose Operative management
0%
1/898
<2 weeks
0%
3/898
2-4 weeks
4%
38/898
5-6 weeks
37%
335/898
7-8 weeks
27%
243/898
9-10 weeks
6%
55/898
11-12 weeks
19%
179/898
>12 weeks
2%
19/898
Outside my area of expertise - best if I don't vote
2%
25/898
PROCEDURE #1
Open reduction and internal fixation of right talus - CPT 28445
OUTCOMES
Post-procedure P1