Surgical Discussion

Patient positioning:  The patient was initially positioned supine for the anteromedial approach to address the talar head shear. Subsequently, the patient was repositioned prone for the posteromedial approach to access the posterior talar body fracture.

Anatomical surgical approach:  The anteromedial approach involved an incision over the anteromedial aspect of the ankle, allowing access to the talar head. For the posteromedial approach, a skin incision was made just medial to the Achilles tendon. The Achilles tendon was retracted laterally, and the deep posterior compartment was retracted medially. A large Homan retractor was used to protect the neurovascular bundle.

The talar head shear was fixed first with the patient supine using an anteromedial approach. The posteromedial approach required distraction to improve visualization of the tibiotalar and subtalar joints, which was crucial for accessing the posterior talar body fracture. Without distraction, this approach would have been ineffective. Fixation was achieved using 1.5 and 2.0 mm screws and plates.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a splint for initial healing, followed by gradual weight-bearing as tolerated. Range of motion exercises were initiated early to prevent stiffness, with progression to strengthening exercises as healing allowed.

Follow up:   Not specified.

Orthopaedic implants used:   1.5 mm screws, 2.0 mm screws, plates.