Ciprian Alin Bardas1, Horea Rares Ciprian Benea2, Dragos Apostu1, Daniel Oltean-Dan1, Gheorghe Tomoaia1,3, Thomas Bauer4,5. 1. "Iuliu Hatieganu" University of Medicine and Pharmacy, Orthopaedics and Traumatology Discipline, 47 Traian Mosoiu St., 400132, Cluj-Napoca, Romania. 2. "Iuliu Hatieganu" University of Medicine and Pharmacy, Orthopaedics and Traumatology Discipline, 47 Traian Mosoiu St., 400132, Cluj-Napoca, Romania. beneahorea@yahoo.com. 3. Academy of Romanian Scientists, 54 Splaiul Independentei St., Bucuresti, Romania. 4. Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100, Boulogne-Billancourt, France. 5. Université de Versailles Saint-Quentin, F-78035, Versailles, France.
Abstract
PURPOSE: The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also the outcomes of this treatment method in a series of four patients. METHODS: Between 2011 and 2019, we have treated in our service a number of four patients with talar neck fractures, by the arthroscopic technique. The surgical intervention consists in arthroscopic exploration of tibiotalar and subtalar joints, arthroscopic lavage and debridement, reduction, and osteosynthesis with two cannulated screws under both arthroscopic and fluoroscopic control. Post-operative care consists in non-weightbearing immobilization for 6 weeks, followed by partial loading under the protection of a walking brace for the next six weeks and ROM exercises. The patients were followed up at three months, when a CT scan was performed, and at one year, when X-ray images showed the consolidation of fractures. RESULTS: Normal or slightly reduced ROM of the ankle and hindfoot was noted in three out of four patients, absence of any pain, or disability (3 patients). The AOFAS' Ankle-Hindfoot scale showed good and excellent results; mean score was 92.75 points (86-98p) at one year after the surgery. CONCLUSION: Arthroscopic-assisted management of talar fractures offers the advantages of minimally invasive surgery combined with good visualization of the fracture, good control of anatomic reduction, and the possibility to treat associated lesions. Main disadvantages of the method are technical difficulties, requires a prolonged learning curve, and offers limited fixation alternatives.
PURPOSE: The purpose of this article is to describe the novel technique of arthroscopic-assisted reduction and internal fixation (ARIF) of talar neck fractures, presenting also the outcomes of this treatment method in a series of four patients. METHODS: Between 2011 and 2019, we have treated in our service a number of four patients with talar neck fractures, by the arthroscopic technique. The surgical intervention consists in arthroscopic exploration of tibiotalar and subtalar joints, arthroscopic lavage and debridement, reduction, and osteosynthesis with two cannulated screws under both arthroscopic and fluoroscopic control. Post-operative care consists in non-weightbearing immobilization for 6 weeks, followed by partial loading under the protection of a walking brace for the next six weeks and ROM exercises. The patients were followed up at three months, when a CT scan was performed, and at one year, when X-ray images showed the consolidation of fractures. RESULTS: Normal or slightly reduced ROM of the ankle and hindfoot was noted in three out of four patients, absence of any pain, or disability (3 patients). The AOFAS' Ankle-Hindfoot scale showed good and excellent results; mean score was 92.75 points (86-98p) at one year after the surgery. CONCLUSION: Arthroscopic-assisted management of talar fractures offers the advantages of minimally invasive surgery combined with good visualization of the fracture, good control of anatomic reduction, and the possibility to treat associated lesions. Main disadvantages of the method are technical difficulties, requires a prolonged learning curve, and offers limited fixation alternatives.