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Fracture Talus:Tips & Tricks of management

Dr.Rajiv ShahFoot & Ankle OrthopaedicsFoot & Ankle SurgeonVadodara, Surat, Gujarat

Management principles

Tips & tricks

Algorithm

Talar fractures

The Basic Principle/s !!!Change of mindset, a must!

BE AGGRESSIVE

BE SUSPICIOUS

Polytrauma casesHindfoot trauma cases

Unresolved ankle sprain casesSuspect…Comminution/ DisplacementGet Canale View Get CT Scan

Vascular compromiseFracture with dislocationDoubt about comminution

Serial check X-rays

Percu. fixation

TIPS: Span Scan Fix

Double Approach

TIPS: Add osteotomy in difficult cases

Trick:Medial malleolar osteotomy

Osteotomy marking: Image check

K-wire as guide

K-wire: Check image

Protection for cartilage: Haemostat

Predrilling

Final Image before osteotomy

Protect TP while doing osteotomy!

Completion with saw

Opening up with osteotome

Use of suture as retractor

Exposure of talar dome

Sutures tied with distractor

Take care of….

Saphenous nerveTalar articualar cartilageTendon of tibialis posterior

Deep part of deltoid ligament

Fixation

Case:

Fixation

Case

Fixation

Trick:Lateral Malleolar osteotomy

Predrilling & tapping – a must

Z or L shaped cutting of ATFL & AITFL & resuturing is a must!!

TRICKS: Lateral screw firstVarious screw configurationUse of plate for comminution

Joysticks must be parallel to fracture line in both the planes

Success Mantras

Which?

What?When?

How?

Which case are you going to deal with? What approach you are going take?

When are you going to approach?

How are you going to fix?

Algorithms

Talar Process Fractures

Small Fragment

DisplacedExcision

In PositionBKPOP

Large Fragment

ORIF

# He

ad T

alus

Non-displacedCR+BKPOP- 4

wks

DisplacedORIF + Screw +/-

Ex Fix

ComminutedPrimary TN fusion

# Bo

dy T

alus

Non-displacedCR+BKPOP- 6

wksWith subtalar dislocation

ORIF + Screws

With total body dislocationMedial malleolar osteotomy

+ ORIF

Crush fracturesMedial + Lateral malleolar

osteotomy

# Ne

ck Ta

lus

HW 1: CR+BKPOP

X-ray checksHW 2:

Percut/ORIF-ScrewsHW 3:

ORIF – Plate-screwsHW 4:

CR + K-wire TN jt

36

Fracture with dislocationClosed Reduction of

Dislocation is attempted

Reducible Non reducible

PlannedTreatment of

fracture

Prompt Open

reduction & fixation

Fracture talus is tough enemy!!!One needs to study & analyze!!!Otherwise… Only complications!!

That’s all…Thank you all..

IFFASCON- 15 at Ludhiana August 28th, 29th & 30th, 2015

20 international faculties

Day 1: Parekh family foundation workshop (7 modules)

Day2 & 3: ConfenrenceA must attend meeting for 2015!