Arthroscopic reduction and internal fixation of talus fractures and on-site soft tissue preserving technique. Talus fractures, although relatively rare, can lead to devastating complications including post-traumatic osteoarthritis of subtalar and tibiotalar joints, osteonecrosis, AVN, malunion, nonunion. The tenuous blood supply of the talus as well as a high incidence of concomitant open fracture pathology has led to controversies surrounding timing and method of tailored fixation. Recent systematic reviews show that all talus fractures are treated with open reduction and internal fixation, but operative technique and method of fixation were highly variable in screw type, size, and or plate fixation. Most experts currently recommend a dual anterior approach for operative fixation, which is associated with soft tissue stripping and possible further compromise of the tailored blood supply. Given that no evidence-based approach or fixation strategy has shown to be superior in tailored fracture fixation, we present a tailored arthroscopic reduction and internal fixation approach that allows for more vascular and soft tissue preservation when compared to the dual anterior incisional approach. The purpose of our study is to present short-term outcomes using our method, excuse me, our posterior talus arthroscopic reduction, internal fixation, or tariff technique. We hypothesize that talus fractures reduced arthroscopically and fixed percutaneously would have similar outcomes with reduced overall complications compared to the traditional open techniques. We've currently performed a retrospective study on 14 patients who have had at least a 90-day follow-up after undergoing our tariff procedure. All cases were performed completely arthroscopically using a posterior approaching cannulated screws. We use cannulated screws to allow for more accurate placement while allowing screws to be placed percutaneously deep into the posterior ankle. Our screws are also titanium, which are MRI compatible and reduces scatter on imaging. The fully threaded screw construct that we use prevents long-term collapse and provides compression. They are also headless. As for our patients and our results, we have had strong follow-up of our cohorts thus far. Currently in Table 1 and 2, you see that there are 14 patients that we present here in our data set. Unfortunately, there are 21 patients, some of which we have yet to have appropriate follow-up. As for the 14 that we've had listed above, many of them are high-level open injuries, some of which are gunshot wounds. For most of these patients, they arrive to our Level 1 Trauma Center and are temporized by our trauma team, many of which are undergoing an open reduction if they have an open injury and then are stabilized with an external fixator. Others are stabilized in a splint, but most in an X-fix, for which then they are referred to our foot and ankle colleagues who manage the rest of their care. Intraoperatively, all of our patients have had two to three anterior to posterior headless compression screws, just depending on the fracture morphology. Postoperatively, all fractures have had articular surface restoration to within two millimeters on radiographs. No patients have required antibiotics and no debridements were performed. We have yet to have acute AVN be recorded. Of our patients, only one has undergone revision as to post-traumatic osteoarthritis at approximately the one-year mark. Two independent radiologists reviewed our post-op radiographs, in which you can see in table two, classified the fracture pattern at injury and evaluated our step-off from our immediate post-op x-rays and then six weeks post-op as well. Our short-term results indicate that posterior arthroscopic reduction in internal fixation of tailous fractures is safe and able to restore the articular surfaces. It also suggests that an on-site soft tissue preserving technique may reduce short-term complications. Thank you for your attention and have a great rest of your day.

arthroscopic reduction

internal fixation

talus fractures

posterior approach

short-term outcomes