1. Case for small group discussion
Talar fracture
Case for small group discussion
AOTrauma—Foot & Ankle
Module 2b: Hindfoot trauma—talar fractures
Stefan Rammelt, DE

2. Case description 42-year-old man Motorcycle accident
Obvious foot deformity
Neurovascular status: intact
Tense, closed soft tissues

3. Discussion Patient transferred with a splint 1 day post injury
CT scan already completed
How would you treat this fracture?
This is not useful for planning. It is superfluous, a waste of time and exposes patient unnecessarily to radiation

4. Closed reduction (1 day post injury)

5. Discussion Which type of fixation would you employ?
Which approaches would you use?

6. Choice of approach after CT

7. Choice of approach after CT
Anteromedial approach to talar neck, head, and medial facet
Oblique lateral approach to talar neck, head, and lateral process

8. Reconstruction Axis, length, rotation
Subtalar joint (anteromedial, lateral, and posteromedial)

9. Intraoperative images

10. Fixation with minifragment plates

11. 6 weeks postoperative
Hawkins sign

12. 1-year follow-up

13. Take-home messages Emergent reduction of dislocations
No need for immediate definitive fixation
CT scans essential for planning approaches/reduction
Anatomical reduction of the joint facets and realignment
In case of central comminution, fixation with minifragment plates
Early motion (after soft-tissue consolidation)
Hawkins sign with 100% specificity

14. References
Rammelt et al. Injury. 2009;40:120–135. Rammelt et al. Oper Orthop Traumatol. 2013; 25:525–541.
Rammelt S, Zwipp H. Talar neck and body fractures. Injury Feb;40(2):120–135.
Rammelt S, Winkler J, Zwipp H. [Operative treatment of central talar fractures]. Oper Orthop Traumatol Dec;25(6):525–541.