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CASE REPORT

Northwell Health Physician Partners Orthopaedic Institute at Huntington

Orthopaedic Surgeon - General Specialty

Northwell Health

postop was NWB for 4 weeks. boot at 2 weeks and progressive range of motion. Fixation was rock solid.

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!

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

Thanks for adding me. Unusual injury. Definite indication for surgery. Seems well accessible through arthroscopy without fibular osteotomy, especially as I‘m placing bets that the ATFL is torn. Flip that fragment with a k-wire or arthroscopic clamp and fix it with Herbert-screw(s). Repair any con...current damage seen on the MRI I‘d get beforehand (talar tilt is suggestive of that). WBAT with FROM.

Lots of ways to approach this. Based on questions posed by Jan Szatkowski, MD, MBA 1) ct is adequate 2) definitely worth trying to fix 3) scope, try and reduce arthroscopically but ultimately can use the torn ATFL to access and fix- personally I think early repair can have some benefit 4) asses...s the deltoid/atifl ligaments and fix if needed 5) fix with either headless or bioabsorbable screws- dealers choice. Personally I like something I don’t worry about having close to the joint 6) have particulate allograft/proximal bone graft for back up

Talus Fracture (other than neck)

PMID: 29456078 J Foot Ankle Surg. 2018 May-Jun;57(3):622-626. Epub 2018 Feb 15.

Transmalleolar Approach for Arthroscopy-Assisted Headless Screw Fixation of an Osteochondral Talar Dome Fracture.

ABSTRACT
- Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome.