A tactical algorithm for minimally invasive reduction of talar fracture-dislocations

Introduction Poor outcomes in the treatment of fracture-dislocations of the talus lead to revision surgeries and disability. A standardized algorithm for minimally invasive reduction is absent.

Purpose Analysis of treatment outcomes in patients with fracture-dislocations of the talus using the developed minimally invasive reduction.

Materials and Methods Data from 46 patients were analyzed. Group A (n = 21) underwent algorithmic reduction, while Group B (n = 25) served as controls. The groups were matched by sex, age, and injury severity. Medical records, CT scans, radiographs, SF-36, and Foot and Ankle Outcome Score (FAOS) questionnaires were assessed and evaluated.

Results In Group A, reduction followed a stepwise approach: Type 1 injuries received instrumental and manual reduction; complex types 2–3 were converted to type 1; multifragmentary fractures (type 4) underwent open reduction. The Ilizarov fixator with ankle hinges was used in Group A. Minimally invasive reduction success rate was three times higher in Group A: 13 cases (62 %) versus 5 (20 %) in Group B. Avascular necrosis occurred in 1 patient (5 %) in Group A versus 9 (36 %) in Group B, 7.2 times less. SF-36 and FAOS scores were significantly higher in Group A. Joint arthrodesis was required 6.7 times more frequently in Group B.

Discussion We achieved low rates of aseptic necrosis and the need for subsequent arthrodesis, as well as good evaluation grading results for minimally invasive reduction techniques in Group A, which is consistent with the authors' opinions using hardware-based reduction and osteosynthesis techniques. A differentiated approach to reduction and patient management depending on the type of talar fracture-dislocation is a distinctive feature of the proposed algorithm.

Conclusions The minimally invasive reduction algorithm is reproducible and triples success rate. The algorithm reduces the complication rate of avascular necrosis and infection rate. The algorithm technique results were superior in functional outcomes (SF-36, FAOS) and therefore reduced arthrodesis necessity. The hinged Ilizarov fixator is crucial for preventing talar collapse and arthritis.

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