Talar neck fractures: anatomic landmarks of suitable position for posterolateral screw insertion

Year 2015, Volume: 49 Issue: 3, 326 - 330, 17.07.2015

Zhenhai Wang Wenqing Qu Dan Wang Zhiyong Zhou Min Yu Dongsheng Zhou

Abstract

Objective: The posterolateral window is a suitable position for screw insertion. The aim of this studywas to define this position for posterolateral screw insertion.
Methods: Fifteen adult cadaver ankles were used in this study. When the ankle was positioned in a neutral position, the posterolateral window was exposed. Height and width of the window were measured.
Vertical distance from the center of the window to the lateral malleolus tip (LMT), horizontal distance from the center of the window to the lateral of the Achilles tendon (LAT), and horizontal distance from the lateral of the Achilles tendon to the sural nerve (SN) were measured. Additionally, the anatomical relationships between the center of the window (the screw insertion point) and surrounding tissues were noted.
Results: The results indicated that the posterolateral window was bounded medially by the lateral tubercle of the posterior process of the talus (LTPT), laterally by the posterior border of lateral malleolar (PBLM), superiorly by the trochlear articular surface (TAS), and inferiorly by the posterior calcaneal facet (PCF). The height and width of the posterolateral window were 1.89±0.04 cm and 0.91±0.01 cm, respectively. LMT was 0.40±0.01 cm, LAT was 0.19±0.02 cm, and SN was 0.62±0.04 cm. The present data showed that posterior screw insertion may be a safer screw insertion technique for talar neck fractures. Performing the operation through the posterolateral window had no negative effect on surrounding tissues such as the flexor hallucis longus and posterior talofibular ligament tissues when the ankle joint was positioned in a neutral position. Additionally, the screw head should be countersunk to reduce intraoperative risk.
Conclusion: The posterolateral window is a safer point for posterolateral screw insertion for talar neck fractures.

Keywords

Anatomical morphology; posterolateral screw insertion; posterolateral window; talar neck fractures.

References

• Xue Y, Zhang H, Pei F, Tu C, Song Y, Fang Y, et al. Treat- ment of displaced talar neck fractures using delayed pro- cedures of plate fixation through dual approaches. Int Or- thop 2014;38:149–54. CrossRef
• Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin 2004;9:723-36. CrossRef
• Pajenda G, Vécsei V, Reddy B, Heinz T. Treatment of talar neck fractures: clinical results of 50 patients. J Foot Ankle Surg 2000;39:365–75. CrossRef
• Halvorson JJ, Winter SB, Teasdall RD, Scott AT. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg 2013;52:56–61. CrossRef
• Rodop O, Mahiroğulları M, Akyüz M, Sönmez G, Turgut H, Kuşkucu M. Missed talar neck fractures in ankle distor- tions. Acta Orthop Traumatol Turc 2010;44:392–6. CrossRef
• Ebraheim NA, Mekhail AO, Salpietro BJ, Mermer MJ, Jackson WT. Talar neck fractures: anatomic consider- ations for posterior screw application. Foot Ankle Int 1996;17:541–7. CrossRef
• Wang ZQ, Yang L, Zhang LY. Clinical Results of Percuta- neous Screw Fixation from Posterolateral of Ankle for 21 Patients with Talar Neck Fracture. J Med Res 2012;6:160– 3.
• Thomas JL, Boyce BM. Radiographic analysis of the Ca- nale view for displaced talar neck fractures. J Foot Ankle Surg 2012;51:187–90. CrossRef
• Isaacs J, Courtenay B, Cooke A, Gupta M. Open reduction and internal fixation for concomitant talar neck, talar body, and medial malleolar fractures: a case report. J Orthop Surg (Hong Kong) 2009;17:112–5.
• Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams T, et al. Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res 2012;98(4 Suppl):S48–55. CrossRef
• Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeor- zan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am 2004;86:1616–24.
• Swanson TV, Bray TJ, Holmes GB Jr. Fractures of the talar neck. A mechanical study of fixation. J Bone Joint Surg Am 1992;74:544–51.
• Capelle JH, Couch CG, Wells KM, Morris RP, Buford WL Jr, Merriman DJ, et al. Fixation strength of anteriorly inserted headless screws for talar neck fractures. Foot An- kle Int 2013;34:1012–6. CrossRef
• Attiah M, Sanders DW, Valdivia G, Cooper I, Ferreira L, MacLeod MD, et al. Comminuted talar neck fractures: a mechanical comparison of fixation techniques. J Orthop Trauma 2007;21:47–51. CrossRef
• Rammelt S, Winkler J, Heineck J, Zwipp H. Anatomical reconstruction of malunited talus fractures: a prospective study of 10 patients followed for 4 years. Acta Orthop 2005;76:588–96. CrossRef
• Di Giorgio L, Touloupakis G, Mastantuono M, Vitullo F, Im- parato L. Chondromyxoid fibroma of the lateral malleolus: a case report. J Orthop Surg (Hong Kong) 2011;19:247–9.