Lateral transligamentous approach to the talar dome

L.-A. Lambert, M. Davies, J. Mangwani, A. Molloy, L. Mason

¹Aintree University Hospital, Aintree University Hospital NHS Foundation Trust, Trauma & Orthopaedics, Liverpool, United Kingdom

²Northern General Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Trauma & Orthopaedics, Merseyside, United Kingdom

³University Hospitals of Leicester, Trauma & Orthopaedics, Leicester, United Kingdom 

Winner of the BOFAS 2019 Third Prize (Podium)

Introduction: Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated a maximum of 25% talar body exposure without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach.

Methods: The lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach, following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion. The talus was disarticulated and high resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid with a perpendicular surgical blade was documented. ImageJ software was used to calculate the surface area exposed with each approach.

Results: The mean percentage area of talar dome available through the transligamentous approach was 77.3 % (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1, 2, 3, 5 & 6 with partial access to Zones 4, 8 & 9.

Conclusion: The lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zone 4 and Zone 7, the posteromedial corner.

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