Talar body fractures are high energy intraarticular injuries that are best management by anatomical reduction and secure fixation to improve outcomes. The talus is relatively inaccessible surgically and requires extensive soft tissue dissection and/or osteotomies to gain adequate open visualisation. There are a small number of case reports on arthroscopic assisted fixation in the literature. This case series reports on the technique and early outcomes of six patients all of whom presented with significant intraarticular displacement and who were managed entirely arthroscopically. The fractures were of the main body of the talus involving the ankle and subtalar joints and all had preoperative CT scans. All six patients underwent posterior ankle and subtalar arthroscopy with cannulated screws used to stabilise the fractures after reduction. Visualisation of the fracture reduction was excellent. After 10 days in a backslab, the patients were protected in a boot and encouraged to actively move their ankles. Weight bearing was permitted once union appeared complete. There were no early complications of infection, avascular necrosis or VTE. There was one patient that had a non-clinically significant migration of a screw. Two patients were lost to follow up early due to being visitors. The mean length of follow up was 12 months in the remainder. The remaining four patients all returned to their preoperative level of activity. All had demonstrable subtalar stiffness. There was no early post-traumatic arthritis. This series represents the largest so far published. The main flaw in this report is the lack of long term follow up. While this report cannot state superiority over open techniques it is a safe, effective and acceptable technique that has significant conceptual benefits.
The National institute of Health and Clinical Excellence (NICE) guidelines for thromboprophylaxis following lower limb surgery and plastercast immobilisation recommend pharmacological prophylaxis be considered until the cast is removed. These guidelines have been extrapolated from data for hip and knee arthroplasty, and trauma studies. Recent studies have questioned the validity of these guidelines. At Portsmouth, low molecular weight heparin (LMWH) is prescribed for 14 days following surgery in high risk patients. The protocol predates the most recent NICE guidance. We set out to investigate whether this was a safe method of thromboprophylaxis following elective hindfoot surgery. A retrospective audit of all patients undergoing hindfoot surgery between 01/01/10 and 31/12/12 was performed. All patients were immobilised in a POP backslab and prescribed 14 days of LMWH. All patients were reviewed at 2 weeks and converted to a full cast or boot. Immobilisation was continued for between 6 and 12 weeks. A list of all patients who had undergone investigation for deep vein thrombosis at Queen Alexandra hospital from 01/01/10 to 28/03/13 was obtained from the VTE investigation department. The two lists were cross referenced to identify any DVTs occurring following hindfoot surgery and plastercast immobilisation.Introduction:
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