OPEN REDUCTION AND INTERNAL SCREW FIXATION FOR TALAR NECK FRACTURES

Indications

• Open reduction and internal screw fixation (ORIF) is used to stabilize a displaced talar neck fracture (Fig. 14.1).

Pre-operative planning

Clinical assessment

• Swelling, neurovascular status, stability.

• Be aware of compartment syndrome (see below). If suspicion for compartment syndrome exists, pressure measurement should be performed (for example with the IntracompartmentalPermanentPressureMonitoring System, StrykerTM Corporation, Santa Clara, CA, USA). Fasciotomy is indicated, if there is a difference of less than 30mmHg between diastolic blood pressure and compartment pressure.

• Be aware of associated fractures in the adjacent foot and ankle (Fig. 14.1a,b).

Radiological assessment

Three standard views:

• Mortise view of the ankle (20° internal rotation).

• True lateral ankle view.

• Anteroposterior (AP) view of the talar neck and head (15° internal foot rotation, 15° caudo-cranial X-ray angle); Canale view.

• CT Scan.

Classification

• Talar neck fractures are classifed according toHawkins, and Canale and Kelly (who added Type IV, Fig. 14.2).

Operative treatment

Anaesthesia

• Regional (spinal/epidural/popliteal) or general anaesthesia.

• Prophylactic antibiotics as per local hospital protocol (e.g. 3rd generation cephalosporin).

Table and equipment

1. 3.5 mm standard cortical and cancellous screws, steel or titanium alloy.

2. Standard osteosynthesis set as per local hospital protocol.

3. A radiolucent table.

4. An image intensifier and a competent radiographer.

Table set up

• The instrumentation set is at the foot end of the table.

• Image intensifier is from the contralateral side.