Open Reduction for AO/OTA 81-B3 (Hawkins 3) Talar Neck Fractures: The Natural Delivery Method

Fractures of the talar neck with subtalar and tibiotalar joint dislocation (AO/OTA 81-B3) represent a treatment challenge for the orthopedic surgeon. The magnitude of deformity and complexity of the pathoanatomy adds to concerns for soft tissue embarrassment to convey an urgency of surgical intervention. Previous studies have described the several techniques for talar reduction, including medial malleolar osteotomy, posterior Schanz pin manipulation, or posteromedial incision to facilitate relocation at the time of definitive open treatment. We describe a simple technique for stepwise surgical intervention using adjuncts to reduction on the surgical field that facilitate an atraumatic relocation of the displaced body fragment through a standard lateral incision, simplifying fixation of the residual talar neck fracture. A reasonable metaphor for the technique is its similarity to reducing an obstetric shoulder dystocia in the delivery of a newborn infant.