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Surgical Management of Posterior Talar Process Fractures

March 01, 2020

Contributors: Philipp Leucht, MD, FAAOS; Dylan Lowe, MD; Blake Joseph Schultz, MD; Jordan Werner, MD; Christian Alexander Pean, MD

Keywords: K-wire

Talar fractures are uncommon, accounting for less than 1% of all fractures. Central and peripheral talus fractures are rare, accounting for less than 0.3% of all fractures. Central and peripheral talus fractures often are missed because they are difficult to identify on plain radiographs. The proximity of central and peripheral talus fractures to the flexor hallucis longus groove may lead to persistent deficits in mobility and pain if not appropriately diagnosed and managed in a timely manner. This video discusses the case presentation of a 58-year-old man who sustained a left lateral subtalar dislocation after a mechanical fall. An obvious ankle deformity with pain on range of motion, swelling, and posteromedial tenderness was noted. The patient was neurovascularly intact with strong pulses. A reduction maneuver was performed in the emergency room, and a short leg splint was immediately applied. Postreduction radiographs and CT scans revealed a left posteromedial talar process fracture. After a discussion of nonsurgical and surgical treatment options, the patient elected to undergo surgical fixation of his posteromedial talar process fracture. The patient was placed in the prone position, a posteromedial incision was used, and provisional reduction, which was obtained with the use of Kirschner wires, aided final fixation with the use of mini-fragment screws. The patient was instructed to remain non-weight bearing for 6 weeks postoperatively. At 2 weeks postoperatively, sutures were removed, the patient was transitioned to a controlled ankle motion walker, and ankle range of motion exercises were initiated. Long-term follow-up is critical to evaluate for arthritic changes, osteonecrosis, collapse, and the integrity of the subtalar and talonavicular joints. Postoperative radiographs revealed a reduced fracture with an adequately positioned fixation construct.