Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected limb elevated on a padded footrest to facilitate access to both the medial and lateral aspects of the hindfoot.

Anatomical surgical approach:  The surgical approach for the talar neck involved dual incisions: a dorsolateral incision was made parallel to the fourth metatarsal, extending proximally towards the lateral malleolus, and a dorsomedial incision was made parallel to the first metatarsal, extending proximally towards the medial malleolus. Subperiosteal dissection was performed to expose the talar neck for reduction and fixation. For the calcaneal fracture, an extensile lateral approach was utilized, with a lateral incision extending from the posterior aspect of the lateral malleolus to the base of the fifth metatarsal, allowing for wide exposure of the calcaneus.

The surgeon emphasized the importance of careful soft tissue handling and intraoperative assessment of vascularity using Doppler ultrasound to ensure flap viability. The sequence of addressing the talus prior to the calcaneus was critical to achieving optimal alignment and fixation. The use of dual approaches for the talar neck was necessary to achieve adequate reduction and fixation.

Postoperative protocol:   Postoperatively, the patient was placed in a non-weight-bearing cast for six weeks, followed by progressive weight-bearing as tolerated. Physical therapy focused on range of motion exercises and gradual strengthening of the hindfoot and ankle.

Follow up:   Not specified

Orthopaedic implants used:   Orthopaedic implants used included cannulated screws for talar neck fixation and a locking plate system for calcaneal fracture stabilization.