Navigierte und minimalinvasive Schraubenosteosynthese einer Talusfraktur

摘要

OBJECTIVE OF SURGERY: The aim of this surgery is to safeguard the multifragmentary and nondisplaced talus fracture (body and neck) against secondary dislocation in a navigated and minimally invasive manner using screw osteosynthesis. INDICATIONS: Due to the young age of the patient in the presented case and the risk of a possible secondary dislocation, the decision was made in favor of surgical treatment. CONTRAINDICATIONS: Soft tissue swelling, wound infections and allergies to the osteosynthesis material. SURGICAL TECHNIQUE: The video is available online (in English) and shows the individual surgical steps in detail. Preoperative computed tomography (CT) imaging and screw planning. Attachment of the reference array. 1) Cone beam CT (CBCT) scan, image fusion and fusion control. Planning of the minimally invasive skin incisions. Skin incision, navigated drilling and insertion of the K‑wires. 2) CBCT scan and position check of the K‑wires, fine adjustment if necessary. Insertion of the screws. 3) CBCT scan with subsequent position check of the screws, retightening of the screws if necessary. Performed in the Robotic Suite (Brainlab, Munich, Germany) using the following elements: navigation unit curve navigation system, movable robotic 3D CBCT, "Loop-X" and wall monitor "BUZZ". FOLLOW-UP: Postoperative X‑ray and CT to control the position of the implants. Partial weight-bearing of the foot with 10 kg sole contact for 6 weeks. Physiotherapy with active and passive joint mobilization. Thrombosis prophylaxis with enoxaparin sodium. Optional implant removal after approximately 1 year. EVIDENCE: Navigated operations are routine, so far mainly in the area of the spine. This article shows that navigated extremity surgery can be successfully performed in hybrid operating theaters.