Treatment of Comminuted Talar Neck Fractures With Use of Minifragment Plating

Abstract

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fractures of the Talus: Current Concepts

“…12 Currently, intraoperative contouring of minifragment plating on the lateral surface of the talus is recommended to avoid medial shortening and varus malunion, particularly in cases of neck shortening greater than 2 mm (Figure 3). 35 Medial plates have proven to be potentially symptomatic, so the use of screws (most commonly headless or countersunk) is often preferred to supplement lateral plate fixation (Figure 3). 30…”

“…15 Further surgical considerations that dictate approach, implant use, and fixation mode include level of fracture comminution, concomitant bony and/or soft tissue injury, and fracture pattern. 35…”

“…35 The sinus tarsi approach is a selective lateral approach that extends from the tip of the lateral malleolus to the base of the fourth ray, exposing the subtalar joint. 35 Percutaneous screw fixation of nondisplaced, noncomminuted talar neck and body fractures can be considered, though strict care to cross the fracture perpendicularly in the anterior-posterior and superior-inferior planes is necessary to achieve maximal fragment compression. 2 This is typically accomplished with 2 screws to minimize rotational forces and can be done as an all-antegrade, all-retrograde, or combined antegrade-retrograde construct.…”

“…15 Further surgical considerations that dictate approach, implant use, and fixation mode include level of fracture comminution, concomitant bony and/or soft tissue injury, and fracture pattern. 35 Combined anteromedial and anterolateral approaches facilitate maximal exposure. 59 The extensile anteromedial approach extends from the tip of the medial malleolus to the base of the first metatarsal with an intermuscular plane between the tibialis anterior and posterior, and exposes the medial talar neck and the anterior tibiotalar articulation.…”

Plate Fixation of Talus Fractures: Where, When, and How?

“…Low rates of malunion have been associated with the use of plates in comminuted neck fractures. 13 17 …”