You think you’re achieving optimal visualization with an open approach to fracture fixation? Would you believe you’re only seeing 14.8% of the total surface area of the talus? This is important.
Amazingly, Only 14.8% of the Talus Is Visible With Open Surgery
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Secondary#anklefracturerepair#talusvisualization
And the solution, says a group of researchers from the University of Arizona, is arthroscopic evaluation of these injuries in order to more completely identify and treat any osteochondral lesions that resulted from the ankle fracture.
The study that quantified what is immediately visible versus what is not, “Talus Visualization in Ankle Fractures: How Much Are We Really Seeing?” was published online on January 7, 2022, in the Orthopaedic Journal of Sports Medicine.
The authors of the paper were hoping to establish a baseline surface area for the talus and then compare that to what is actually visible using an open approach to ankle fracture repair.
Why do we care? Because, wrote the authors: “Despite appropriate care, a subset of patients with ankle fractures has persistent pain. This condition may be associated with intra-articular pathology, which is present up to 65% of the time.”
The research team collected data from standard ankle approaches to lateral and medial malleolar fractures in 4 cadaveric ankles from 2 cadavers. They then compared the amount of cartilage removed to the entire weightbearing surface portion of the talus.
Overall, the mean surface area of the talus was 14.0 cm2 (95% CI, 13.3-14.7 cm2), while the mean area visible via an open approach was 2.1 cm2 (95% CI, 0.5-3.6 cm2). The mean proportion of the talus visualized via an open approach was 14.8% (95% CI, 3.6-26.1%).
“These findings indicate that the true area of weightbearing talar surface visible during an open exposure may be less than what many surgeons postulate,” they wrote.
“Only a small fracture of the talus is visible via an open approach to the talus during fracture fixation. This could warrant arthroscopic evaluation of these injuries to evaluate and treat osteochondral lesions resulting from ankle fractures.”
The study authors included Nathaniel B. Hinckley, D.O., Jeffrey D. Hassebrock, M.D., Phillip J. Karsen, David G. Deckey, M.D., Todd A. Kile, M.D. and Karan A. Patel, M.D. of Mayo Clinic Arizona as wells as Andrea Fernandez of the University of Arizona College of Medicine and Mark C. Drakos, M.D. of Hospital for Special Surgery in New York.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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