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# of the talar neck treated with ORIF. After surgery, the patient initially had a bulky compressive dressing. The # was placed in a cast after the edema subsided. Talar #s tend to have less swelling than calcaneal #s.
Anatomic realignment is more critical for the articular surfaces of the talus than for any other bone in the foot. This is because of the high risk of avascular necrosis due to a poor blood supply.
Stable fixation of talar neck #s is crucial to reduce the risk of avascular necrosis of the talar head. #s of the talar body must be stably fixed to restore subtalar joint congruity. #s of the talar head must be stably maintained to allow for load transfer across the talonavicular joint.
#s of talus are initially placed in a bulky compressive dressing or cast with the foot elevated for 2-5 days.
When a walking cast is applied, the patient may be allowed wt-bearing (wt of leg) if the fixation can tolerate it.
It is very important with talar #s for the patient to keep the foot elevated as much as possible in the first 3 weeks to optimize circulation to the talus, in the hope of preventing avascular necrosis (Figs. 31-11 & 12).
In the dependent position, there is inadequate venous return secondary to the vascular congestion caused by the swelling.
Early motion is extremely important for a satisfactory final outcome, and the patient with rigid internal screw fixation frequently is put in a bivalve cast or removable cam walker ( a rigid, padded, supportive splint with a rocker bottom) 2 weeks after surgery to expedite exercise of the joints.
The patient should ideally remain partial wt-bearing for up to 3 months and then progress with wt-bearing as tolerance and radiographic evidence of healing suggest.