Does a Medial Malleolar Osteotomy or Posteromedial Approach Provide Greater Surgical Visualization for the Treatment of Talar Body Fractures?
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
15 12 2021
15 12 2021
Historique:
pubmed:
14
10
2021
medline:
27
1
2022
entrez:
13
10
2021
Statut:
ppublish
Résumé
Surgical management of talar body fractures is influenced by soft-tissue condition and fracture pattern. Two common surgical approaches for the treatment of talar body fractures are the medial malleolar osteotomy (MMO) and the posteromedial approach (PMA). The purpose of this study was to compare the observable talar body surface area with the MMO and the PMA. We hypothesized that visualization following a PMA improves with distraction and distraction with a gastrocnemius recession. Five pairs of cadaver limbs were used. Each pair of specimens underwent both approaches to act as an internal control. The laterality of the PMA was determined by randomization, and the MMO was performed on the contralateral ankle. The PMA was performed to visualize the talus, and the talar surface area was recorded using a handheld 3D surface scanner. A distractor was then placed across the joint, and the surface area was remeasured. Finally, a gastrocnemius recession was performed, and the measured surface area under the distraction was recorded. The MMO was performed in standard fashion using fluoroscopy, and the observable talar surface area was recorded. Scans were performed twice for each approach, and the surface areas were averaged. The talus was excised and scanned after each approach in order to compare the visualized surface area with the total surface area of the native talus. The MMO and the PMA exposed a mean of 11.2 and 6.7 cm2, respectively, of the talar surface. Visualization with the PMA was improved with distraction, revealing 8.3 cm2 of the talus (p = 0.01 when compared with an isolated PMA). A PMA with distraction and gastrocnemius recession exposed 9.9 cm2 of the talar dome and body. There was no significant difference in exposure between the MMO and the PMA with distraction and gastrocnemius recession (p = 0.32). The MMO and the PMA both afford excellent visualization for reduction and fixation of talar body fractures. Visualization using the PMA is improved with distraction and distraction with a gastrocnemius recession. The results of this study may assist surgeons in selecting the optimal approach for surgical repair of talar body fractures.
Sections du résumé
BACKGROUND
Surgical management of talar body fractures is influenced by soft-tissue condition and fracture pattern. Two common surgical approaches for the treatment of talar body fractures are the medial malleolar osteotomy (MMO) and the posteromedial approach (PMA). The purpose of this study was to compare the observable talar body surface area with the MMO and the PMA. We hypothesized that visualization following a PMA improves with distraction and distraction with a gastrocnemius recession.
METHODS
Five pairs of cadaver limbs were used. Each pair of specimens underwent both approaches to act as an internal control. The laterality of the PMA was determined by randomization, and the MMO was performed on the contralateral ankle. The PMA was performed to visualize the talus, and the talar surface area was recorded using a handheld 3D surface scanner. A distractor was then placed across the joint, and the surface area was remeasured. Finally, a gastrocnemius recession was performed, and the measured surface area under the distraction was recorded. The MMO was performed in standard fashion using fluoroscopy, and the observable talar surface area was recorded. Scans were performed twice for each approach, and the surface areas were averaged. The talus was excised and scanned after each approach in order to compare the visualized surface area with the total surface area of the native talus.
RESULTS
The MMO and the PMA exposed a mean of 11.2 and 6.7 cm2, respectively, of the talar surface. Visualization with the PMA was improved with distraction, revealing 8.3 cm2 of the talus (p = 0.01 when compared with an isolated PMA). A PMA with distraction and gastrocnemius recession exposed 9.9 cm2 of the talar dome and body. There was no significant difference in exposure between the MMO and the PMA with distraction and gastrocnemius recession (p = 0.32).
CONCLUSIONS
The MMO and the PMA both afford excellent visualization for reduction and fixation of talar body fractures. Visualization using the PMA is improved with distraction and distraction with a gastrocnemius recession. The results of this study may assist surgeons in selecting the optimal approach for surgical repair of talar body fractures.
Identifiants
pubmed: 34644268
doi: 10.2106/JBJS.21.00299
pii: 00004623-202112150-00009
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2324-2330Informations de copyright
Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G742).
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