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.
12.
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.
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.
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.