Baez

3. Mortise view of the ankle demonstrating impacted
fracture of the talar body (arrows).

5. Closeup of previous figure.

7. The vertical fracture is well seen on the AP radiograph of the ankle.

8. Lateral radiograph of the ankle.

9. CAT scan views from more proximal to more distal demonstrating
the talar body fracture traversing the dome and entering the
medial body.

10. CAT scan views from more proximal to more distal demonstrating
the talar body fracture traversing the dome and entering the
medial body.

11. CAT scan views from more proximal to more distal demonstrating
the talar body fracture traversing the dome and entering the
medial body.

13. POSTERIOR TIBIAL
TENDON
DELTOID
LIGAMENT
MEDIAL
MALLEOLUS
The patient is positioned supine with a bump under the contralateral hip,
allowing for external rotation of the affected side. A direct medial incision
is made over the medial malleolus centered over the anterior colliculus.
Visualized in the wound are the medial malleolus, deltoid ligament and
posterior tibial tendon.

14. Before performing the medial malleolar osteotomy, the medial
malleolus is predrilled and tapped for the postosteotomy fixation.

15. The osteotome is placed up against the medial malleolus in a direction
to come through just lateral to the medial corner of the joint.

16. Dotted lines indicate position of the osteotomy.

17. After the osteotomy is performed, the retinaculum of the posterior
tibial tendon sheath must be released to reflect the medial malleolus
distally on the deltoid ligament (dotted lines).

18. After the osteotomy is performed, the retinaculum to the posterior
tibial tendon sheath must be released to reflect the medial malleolus
distally on the deltoid ligament (dotted lines).

19. ANTERIOR
COLLICULUS
POSTERIOR
COLLICULUS
DELTOID
LIGAMENT
After the osteotomy is performed, the retinaculum to the posterior
tibial tendon sheath must be released to reflect the medial malleolus
distally on the deltoid ligament (dotted lines).

20. MEDIAL
MALLEOLUS TALUS
With reflection of the medial malleolar fragment distally, the
talar dome is very easily visualized. If the osteotomy exits
inferiorly to the corner of the joint, it will be difficult to see
across the joint.

21. MEDIAL
MALLEOLUS
PLAFOND ARTICULAR SURFACE
IMPACTED
TALAR
DOME
A wide view of the field, demonstrating the medial malleolus,
reflected distally on the deltoid, and good visualization of the
impacted talar dome.

22. Closeup of impacted talar dome.

23. After a manipulative reduction of the impacted segment is
performed, K-wires can be utilized to hold the reduction.

25. REDUCED
FRACTURE
LINES
Another view of the reduction.

26. The fracture is fixed with Herbert screws. This figure demonstrates
an anatomic reduction of the impacted segment.

27. Dissection of the posterior tibial tendon was necessary to allow
fixation of the posteromedial process with an additional screw.

28. Immediate postoperative AP radiograph of the ankle,
demonstrating anatomic reduction of the talus.

29. Radiographs at three months, when weight bearing was initiated.
There is no sign of collapse and there is some bone resorption,
indicating good vascularity to the body.