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Subtalar Dislocations
Posted: Dec 9 2020 #(C101666)
A

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.

Poll
1 of 10
1. In addition to the plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
9%
103/1127
Yes - additional radiographs (XR)
0%
6/1127
Yes - CT scan of the foot/ankle (CT)
74%
837/1127
Yes- MRI scan of the foot/ankle (MRI)
2%
23/1127
Yes - XR + CT
9%
106/1127
Yes - XR + MRI
0%
4/1127
Yes - MRI + CT
1%
14/1127
Yes - XR + CT + MRI
1%
14/1127
Outside my area of expertise - best if I don't vote
1%
20/1127
2. Would you use a classification system for this injury to guide management?`
No - a classification system would not help me
29%
310/1065
Yes - AO/OTA
15%
162/1065
Yes - Hawkins
47%
502/1065
Yes - Other
1%
18/1065
Outside my area of expertise - best if I don't vote
6%
73/1065
3. How would you defintiively manage this patient?
Nonoperative
1%
19/1072
Operative
96%
1034/1072
Outside my area of expertise - best if I don't vote
1%
19/1072
4. If you choose Operative management, would you temporize this patient prior to definitive fixation?
I would not choose Operative management
0%
6/1049
No - I would fix this acutely
43%
455/1049
Yes - Splint
30%
322/1049
Yes - External fixation
22%
238/1049
Outside my area of expertise - best if I don't vote
2%
28/1049
5. If you choose Operative management, what treatment would you plan for and perform?
I would not choose Operative management
0%
1/1040
External fixation (ExFix) only (includes monoplanar, ringed circular fixation, etc)
1%
12/1040
Closed reduction percutaneous fixation (CRPP) (includes pins and/or screws)
12%
125/1040
Open reduction internal fixation (ORIF) (includes plate, screws, wires, minimally invasive plate)
81%
844/1040
Arthrodesis
2%
22/1040
Outside my area of expertise - best if I don't vote
3%
36/1040
6. If you choose Open reduction internal fixation (ORIF), which implants would you utilize?
I would not choose ORIF
0%
8/1013
K-wires only
0%
3/1013
Screws only
30%
306/1013
Staples only
0%
3/1013
Screw(s) and K-wire(s)
26%
265/1013
Screw(s) and staple(s)
3%
38/1013
Staple(s) and K-wire(s)
0%
5/1013
Plate and screws
33%
338/1013
Other
0%
1/1013
Outside my area of expertise - best if I don't vote
4%
46/1013
7. If you choose Open reduction internal fixation (ORIF), what approach would you use?
I would not choose ORIF
0%
7/988
Anteromedial only
13%
136/988
Anterolateral only
6%
61/988
Lateral only
1%
18/988
Posteromedial only
16%
166/988
Posterolateral only
3%
38/988
Dual Incision - Combination of two above approaches
48%
480/988
Three Incision - Combination of three above approaches
1%
10/988
Outside my area of expertise - best if I don't vote
7%
72/988
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%
103/904
Tibialis posterior (TP) tendon subsheath
11%
104/904
Between TP and Flexor digitorum longus (FDL)
27%
253/904
Between FDL and NV bundle
5%
51/904
Between NV bundle and flexor hallicus longus (FHL)
7%
71/904
Between FHL and Achilles tendon
22%
202/904
Outside my area of expertise - best if I don't vote
13%
120/904
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%
1/893
Non-weight-bearing (NWB)
84%
757/893
Partial weight bearing
1%
15/893
Touch-down weight bearing
4%
42/893
Toe-touch weight bearing
4%
40/893
Weight-bearing as tolerated
1%
13/893
Outside my area of expertise - best if I don't vote
2%
25/893
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%
1/911
<2 weeks
0%
3/911
2-4 weeks
4%
38/911
5-6 weeks
37%
339/911
7-8 weeks
27%
247/911
9-10 weeks
6%
55/911
11-12 weeks
19%
182/911
>12 weeks
2%
19/911
Outside my area of expertise - best if I don't vote
2%
27/911
PROCEDURE #1

Open reduction and internal fixation of right talus - CPT 28445

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OUTCOMES
Post-procedure P1
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