talar fracture - very shortcme.uthscsa.edu/update/presentations/thursday/talar...• avn may be...

44THTH ANNUALANNUALEX FIX SYMPOSIUMEX FIX SYMPOSIUM

CONSIDERATIONSCONSIDERATIONS

1. FORCED DORSIFLEXIONOF TALUS?INVERSIONCANTILEVER

2. BLOOD SUPPLY3. BIOMECHANICS

4th Annual International External Fixation Symposium

December 11-14, 2008

1

HAWKINSHAWKINSCLASSIFICATIONCLASSIFICATION

GROUP/TYPE IGROUP/TYPE IIGROUP/TYPE IIIGROUP/TYPE IV*

FAST ROPING INJURYFAST ROPING INJURYTYPE II FX ?TYPE II FX ?



2

REALLY REALLY TYPE IVTYPE IV

MEDIAL MEDIAL APPROACHAPPROACH



3

LATERAL LATERAL APPROACHAPPROACH

POSTPOST--OPOPXX--RAYRAY



4

MOTORCYCLE ACCIDENTMOTORCYCLE ACCIDENTTYPE I ?TYPE I ?

REALLY TYPE IIREALLY TYPE II



5

POSTPOST--OPOP

WHEREWHERE’’SSTHE FX ?THE FX ?



6

ANKLE/SUBTALARANKLE/SUBTALARDISLOCATIONDISLOCATION

CT SCANCT SCAN



7

SCREWS THROUGHSCREWS THROUGHTALAR HEADTALAR HEAD

POSTPOST--OPOP



8

THAT HADTHAT HADTOO HURTTOO HURT

WHAT LOOKSWHAT LOOKSWORSE?WORSE?



9

ARTICULARARTICULARDAMAGEDAMAGE

POSTPOST--OPOP



10

HERE WEHERE WEGO AGAINGO AGAIN

MEDIALMEDIALCOMMINUTIONCOMMINUTION



11

MEDIAL TALARMEDIAL TALARPLATEPLATE

TALARTALARPLATINGPLATING



12

VASCULARITYVASCULARITYAVNAVN

WHAT DOWHAT DOI DO WITH AVN!I DO WITH AVN!

• AVN DOES NOT NECESSARILY COMPROMISE RESULT

• AVN MAY BE PARTIAL OR COMPLETE• COLLAPSE IS NOT ENVITABLE• COMFORT: 12 AVN ONLY ONE COLLAPSE• TX: IMMOBILIZATION & NWB• HOW LONG NWB? ART OF SURGERY!• BORNER 6 M/VECSEI 1 Y/KAZR 1.5 YS• TAKES 3 YRS TO REVASCULARIZE• EVALUATION: BONE SCAN/MRI



13

REAL PROBLEMREAL PROBLEMARTHRITISARTHRITIS

•• GROB ET AL.GROB ET AL.STJ 37% & ANKLE 32%

•• MINDELL ET AL.MINDELL ET AL.STJ 75%

•• PEENELPEENELSTJ 60% IN T-III FX

•• SZYSKOWITZ ET AL. SZYSKOWITZ ET AL. –– 69 PTS69 PTSSTJ 39 PTS AND ANKLE 38 PTS

•• FRAWLEY ET AL. FRAWLEY ET AL. –– 20 PTS20 PTSSTJ 16 PTS & ANKLE 4 PTS

NOT GOODNOT GOOD



14

WISH I WISH I DIDNDIDN’’T LOOKT LOOK

ABSORABLEABSORABLESCREWSCREW



15

APPEARS PRETTYAPPEARS PRETTYDAMN GOODDAMN GOOD

MULTIPLE FXMULTIPLE FX



16

MULTIPLE FXMULTIPLE FX

CT SCANCT SCAN



17

MEDIAL MALLEOLARMEDIAL MALLEOLAROSTEOTOMYOSTEOTOMY

POSTPOST--OPOP



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TALAR BODY FXTALAR BODY FXPILON FXPILON FX

COMMINUTEDCOMMINUTEDTALAR BODY FXTALAR BODY FX



19

MODIFIEDMODIFIEDBLAIR FUSIONBLAIR FUSION

LATE SALVAGELATE SALVAGEARTHRODESISARTHRODESIS



20

DISTRACTIONDISTRACTIONARTHRODESISARTHRODESIS

OPEN TYPE IIIOPEN TYPE III



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CONFUSEDCONFUSED

YOU’RE # 1



22

POSTERIORPOSTERIORSCREW FIXATIONSCREW FIXATION

FRACTURESFRACTURESGOING EVERYWHEREGOING EVERYWHERE



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talar fracture - very shortcme.uthscsa.edu/update/presentations/thursday/talar...• avn may be...

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