Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected lower extremities prepared for dual approach access.

Anatomical surgical approach:  A dual approach was employed: a medial approach to the talus via an incision along the medial malleolus, and a lateral approach via an incision over the lateral malleolus. Subperiosteal dissection was performed to expose the talar neck and head. Distractors were applied medially and laterally to achieve initial restoration of talar morphology.

The talar fractures were highly comminuted, necessitating meticulous reduction through distraction followed by fine-tuning via open approaches. Medial and lateral plates were applied due to the complexity of the fractures. A significant medial bone defect was packed with cancellous allograft. The anterior process of the calcaneus was disimpacted and fixed to address calcaneocuboid joint incongruity, as emphasized by senior foot and ankle partners.

Postoperative protocol:   The patient will remain in an external fixator for 8 weeks to protect internal fixation. Weight-bearing will be restricted during this period, with gradual progression based on radiographic healing and clinical assessment.

Follow up:   Not specified.

Orthopaedic implants used:   Medial and lateral plates, cancellous allograft, external fixator.