lecture 14 shah fracture talus
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Fracture Talus:Tips & Tricks of management
Dr.Rajiv ShahFoot & Ankle OrthopaedicsFoot & Ankle SurgeonVadodara, Surat, Gujarat
Management principles
Tips & tricks
Algorithm
Talar fractures
The Basic Principle/s !!!Change of mindset, a must!
BE AGGRESSIVE
BE SUSPICIOUS
Polytrauma casesHindfoot trauma cases
Unresolved ankle sprain casesSuspect…Comminution/ DisplacementGet Canale View Get CT Scan
Vascular compromiseFracture with dislocationDoubt about comminution
Serial check X-rays
Percu. fixation
TIPS: Span Scan Fix
Double Approach
TIPS: Add osteotomy in difficult cases
Trick:Medial malleolar osteotomy
Osteotomy marking: Image check
K-wire as guide
K-wire: Check image
Protection for cartilage: Haemostat
Predrilling
Final Image before osteotomy
Protect TP while doing osteotomy!
Completion with saw
Opening up with osteotome
Use of suture as retractor
Exposure of talar dome
Sutures tied with distractor
Take care of….
Saphenous nerveTalar articualar cartilageTendon of tibialis posterior
Deep part of deltoid ligament
Fixation
Case:
Fixation
Case
Fixation
Trick:Lateral Malleolar osteotomy
Predrilling & tapping – a must
Z or L shaped cutting of ATFL & AITFL & resuturing is a must!!
TRICKS: Lateral screw firstVarious screw configurationUse of plate for comminution
Joysticks must be parallel to fracture line in both the planes
Success Mantras
Which?
What?When?
How?
Which case are you going to deal with? What approach you are going take?
When are you going to approach?
How are you going to fix?
Algorithms
Talar Process Fractures
Small Fragment
DisplacedExcision
In PositionBKPOP
Large Fragment
ORIF
# He
ad T
alus
Non-displacedCR+BKPOP- 4
wks
DisplacedORIF + Screw +/-
Ex Fix
ComminutedPrimary TN fusion
# Bo
dy T
alus
Non-displacedCR+BKPOP- 6
wksWith subtalar dislocation
ORIF + Screws
With total body dislocationMedial malleolar osteotomy
+ ORIF
Crush fracturesMedial + Lateral malleolar
osteotomy
# Ne
ck Ta
lus
HW 1: CR+BKPOP
X-ray checksHW 2:
Percut/ORIF-ScrewsHW 3:
ORIF – Plate-screwsHW 4:
CR + K-wire TN jt
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Fracture with dislocationClosed Reduction of
Dislocation is attempted
Reducible Non reducible
PlannedTreatment of
fracture
Prompt Open
reduction & fixation
Fracture talus is tough enemy!!!One needs to study & analyze!!!Otherwise… Only complications!!
That’s all…Thank you all..
IFFASCON- 15 at Ludhiana August 28th, 29th & 30th, 2015
20 international faculties
Day 1: Parekh family foundation workshop (7 modules)
Day2 & 3: ConfenrenceA must attend meeting for 2015!