Posteromedial approach for the surgical management of posterior talar body fractures

Posterior talar body fractures are challenging with regards to optimal surgical approach, especially fractures involving the articular surface for which anatomical reduction is required. These fractures are often reduced surgically utilizing either the medial malleolus osteotomy (MMO), or posteromedial approach (PMA). While the MMO exposes the medial aspect of the body of the talus and avoids compromising the blood supply to the anterior talus through the deltoid ligament, it provides minimal access to the posterior process and to the posteromedial talar dome. Furthermore, by definition this approach results in iatrogenic damage to the articular cartilage and a trace loss of bone at the osteotomy site, which may preclude an anatomic reduction. The PMA on the other hand provides visualization of the entire posterior talus, including the posterior process and posterior aspect of the talar dome, thus it may indicated for appropriate reduction and visualization of fractures of these sites. This article describes the technique and reports on outcomes in the largest series of patients reported in the literature to our knowledge who sustained posterior talar body fractures that were managed through this approach.