Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP

2019 ◽  
Vol 129 (3) ◽  
pp. 230-237
Author(s):  
Vijay A. Patel ◽  
Mitchell Dunklebarger ◽  
Kalins Banerjee ◽  
Tom Shokri ◽  
Xiang Zhan ◽  
...  
Keyword(s):  
Surgical Management ◽  
Vestibular Schwannoma ◽  
Surgical Complication ◽  
Treatment Strategies ◽  
Surgical Approaches ◽  
Annual Number ◽  
Complication Rates ◽  
Entire Study ◽  
Acs Nsqip ◽  
Significant Difference

Objective: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. Methods: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. Results: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI ( P < .001), ASA class ( P = .004), ethnicity ( P = .008), operative time ( P < .001), and reoperation ( P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. Conclusions: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.

scholarly journals Outcomes of Primary Repair and Anastomosis for Traumatic Colonic Injuries in a Tertiary Trauma Center

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 440
Author(s):  
Marie Shella De Robles ◽  
Christopher J. Young
Keyword(s):  
Surgical Management ◽  
Trauma Center ◽  
Primary Repair ◽  
Length Of Hospital Stay ◽  
Injury Mechanism ◽  
Complication Rates ◽  
Colonic Injury ◽  
Significant Difference ◽  
Injured Part ◽  
Resection And Anastomosis

Background: Surgical management for traumatic colonic injuries has undergone major changes in the past decades. Despite the increasing confidence in primary repair for both penetrating colonic injury (PCI) and blunt colonic injury (BCI), there are authors still advocating for a colostomy particularly for BCI. This study aims to describe the surgical management of colonic injuries in a level 1 metropolitan trauma center and compare patient outcomes between PCI and BCI. Methods: Twenty-one patients who underwent trauma laparotomy for traumatic colonic injuries between January 2011 and December 2018 were retrospectively reviewed. Results: BCI accounted for 67% and PCI for 33% of traumatic colonic injuries. The transverse colon was the most commonly injured part of the colon (43%), followed by the sigmoid colon (33%). Primary repair (52%) followed by resection-anastomosis (38%) remain the most common procedures performed regardless of the injury mechanism. Only two (10%) patients required a colostomy. There was no significant difference comparing patients who underwent primary repair, resection-anastomosis and colostomy formation in terms of complication rates (55% vs. 50% vs. 50%, p = 0.979) and length of hospital stay (21 vs. 21 vs. 19 days, p = 0.991). Conclusions: Regardless of the injury mechanism, either primary repair or resection and anastomosis is a safe method in the management of the majority of traumatic colonic injuries.

scholarly journals Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092610
Author(s):  
Huai Ming Phen ◽  
Wesley J. Manz ◽  
Danielle Mignemi ◽  
Joel T. Greenshields ◽  
Jason T. Bariteau
Keyword(s):  
Linear Regression ◽  
Wound Infection ◽  
Surgical Management ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Complication Rates ◽  
Sf 36 ◽  
Significant Difference ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.

Discrepancy in Postoperative Outcomes between Auditing Databases: A NSQIP Comparison

2018 ◽  
Vol 84 (8) ◽  
pp. 1294-1298 ◽  
Author(s):  
William B. Lyman ◽  
Michael Passeri ◽  
Allyson Cochran ◽  
David A. Iannitti ◽  
John B. Martinie ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Statistical Significance ◽  
Postoperative Pancreatic Fistula ◽  
Complication Rates ◽  
Audit System ◽  
Acs Nsqip ◽  
Outcome Reporting ◽  
Significant Difference ◽  
Chi Squared

In 2014, ACS-NSQIP® targeted pancreatectomies to improve outcome reporting and risk calculation related to pancreatectomy. At the same time, our department began prospectively collecting data for pancreatectomy in the Enhanced Recovery After Surgery® Interactive Audit System (EIAS). The purpose of this study is to compare reported outcomes between two major auditing databases for the same patients undergoing pancreatectomy. The same 171 patients were identified in both databases. Clinical outcomes were then obtained from each database and compared to determine whether reported complication rates were statistically different between auditing databases. A combination of Wilcoxon rank sum and Pearson's chi-squared tests were used to calculate statistical significance. No significant difference was appreciated in captured demographics between EIAS and NSQIP. Significant differences in reported rates for renal dysfunction, postoperative pancreatic fistula, return to the operative room, and urinary tract infection were noted between EIAS and NSQIP. Although significant differences in reported complication rates were demonstrated between EIAS and NSQIP for pancreatectomy, much of the discrepancy is attributable to subtle differences in definitions for postoperative occurrences between the two auditing databases. It is vital for surgeons to understand the exact definition that determines the complication rate for a given database.

scholarly journals Surgical Management of Idiopathic Perianal Fistulas: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-16
Author(s):  
Xinyi Cherry Cheung ◽  
Tom Fahey ◽  
Ailin C. Rogers ◽  
John Hogeland Pemberton ◽  
Dara Oliver Kavanagh
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Perianal Fistula ◽  
Surgical Approaches ◽  
Supporting Evidence ◽  
Minimal Risk ◽  
Recurrence Rates ◽  
Perianal Fistulas ◽  
Extensive Evaluation ◽  
Significant Difference

<b><i>Background:</i></b> Perianal fistula is a common colorectal condition with an incidence of 9 per 100,000. Many surgical treatments exist, all aiming to eliminate symptoms with minimal risk of recurrence and impact upon continence. Despite extensive evaluation of the therapeutic modalities, no clear consensus exists as to what is the gold standard approach. This systematic review aimed to examine all available evidence pertaining to the surgical management of perianal fistulas. Primary outcomes examined were recurrence and incontinence. <b><i>Summary:</i></b> This study was conducted according to PRISMA guidelines. Primary outcomes were analyzed for each group and expressed as pooled odds ratio with confidence intervals of 95%. 687 studies were identified from which 28 relevant studies were included. There was no significant difference in rates of incontinence identified between various surgical approaches. Glues and plugs show higher recurrence rates. Newer treatments continue to emerge with promise but lack supporting evidence of benefit over conventional therapies. <b><i>Key Messages:</i></b> While we await more robust randomized data, we will continue to proceed cautiously trying to offset the benefits of fistula healing against the inherent risk of altered continence.

scholarly journals Minimally invasive spine surgery for adult degenerative lumbar scoliosis

2014 ◽  
Vol 36 (5) ◽  
pp. E7 ◽  
Author(s):  
Sean Dangelmajer ◽  
Patricia L. Zadnik ◽  
Samuel T. Rodriguez ◽  
Ziya L. Gokaslan ◽  
Daniel M. Sciubba
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Open Surgery ◽  
Meta Analysis ◽  
Surgical Approaches ◽  
Degenerative Lumbar Scoliosis ◽  
Complication Rates ◽  
Minimally Invasive Surgical ◽  
Significant Difference ◽  
Lateral Interbody

Object Historically, adult degenerative lumbar scoliosis (DLS) has been treated with multilevel decompression and instrumented fusion to reduce neural compression and stabilize the spinal column. However, due to the profound morbidity associated with complex multilevel surgery, particularly in elderly patients and those with multiple medical comorbidities, minimally invasive surgical approaches have been proposed. The goal of this meta-analysis was to review the differences in patient selection for minimally invasive surgical versus open surgical procedures for adult DLS, and to compare the postoperative outcomes following minimally invasive surgery (MIS) and open surgery. Methods In this meta-analysis the authors analyzed the complication rates and the clinical outcomes for patients with adult DLS undergoing complex decompressive procedures with fusion versus minimally invasive surgical approaches. Minimally invasive surgical approaches included decompressive laminectomy, microscopic decompression, lateral and extreme lateral interbody fusion (XLIF), and percutaneous pedicle screw placement for fusion. Mean patient age, complication rates, reoperation rates, Cobb angle, and measures of sagittal balance were investigated and compared between groups. Results Twelve studies were identified for comparison in the MIS group, with 8 studies describing the lateral interbody fusion or XLIF and 4 studies describing decompression without fusion. In the decompression MIS group, the mean preoperative Cobb angle was 16.7° and mean postoperative Cobb angle was 18°. In the XLIF group, mean pre- and postoperative Cobb angles were 22.3° and 9.2°, respectively. The difference in postoperative Cobb angle was statistically significant between groups on 1-way ANOVA (p = 0.014). Mean preoperative Cobb angle, mean patient age, and complication rate did not differ between the XLIF and decompression groups. Thirty-five studies were identified for inclusion in the open surgery group, with 18 studies describing patients with open fusion without osteotomy and 17 papers detailing outcomes after open fusion with osteotomy. Mean preoperative curve in the open fusion without osteotomy and with osteotomy groups was 41.3° and 32°, respectively. Mean reoperation rate was significantly higher in the osteotomy group (p = 0.008). On 1-way ANOVA comparing all groups, there was a statistically significant difference in mean age (p = 0.004) and mean preoperative curve (p = 0.002). There was no statistically significant difference in complication rates between groups (p = 0.28). Conclusions The results of this study suggest that surgeons are offering patients open surgery or MIS depending on their age and the severity of their deformity. Greater sagittal and coronal correction was noted in the XLIF versus decompression only MIS groups. Larger Cobb angles, greater sagittal imbalance, and higher reoperation rates were found in studies reporting the use of open fusion with osteotomy. Although complication rates did not significantly differ between groups, these data are difficult to interpret given the heterogeneity in reporting complications between studies.

scholarly journals Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

2019 ◽  
Vol 30 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Julia Onken ◽  
Kathrin Obermüller ◽  
Franziska Staub-Bartelt ◽  
Bernhard Meyer ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Posterior Approach ◽  
Surgical Complication ◽  
Extent Of Resection ◽  
Surgical Approaches ◽  
Special Focus ◽  
Complication Rates ◽  
Duration Of Surgery ◽  
Spinal Meningiomas

OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

The Perioperative Continuation of Aspirin in Patients Undergoing Arthroscopic Surgery of the Knee

2019 ◽  
Vol 47 (9) ◽  
pp. 2138-2142
Author(s):  
Ljiljana Bogunovic ◽  
Amanda K. Haas ◽  
Robert H. Brophy ◽  
Matthew J. Matava ◽  
Matthew V. Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroscopy ◽  
Surgical Complication ◽  
Arthroscopic Surgery ◽  
Wound Complications ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Hematoma Formation ◽  
Significant Difference ◽  
Daily Aspirin

Background: The perioperative withdrawal of aspirin increases the risk of cardiac, neurologic, and vascular thromboembolic events. The safety of continuing aspirin in patients undergoing knee arthroscopy is unknown. Hypothesis: Perioperative continuation of aspirin does not increase surgical complications or worsen outcomes in patients 50 years of age and older undergoing knee arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: This is a single-center, institutional review board–approved, prospective matched dual-cohort study comparing the surgical complication rates and postoperative outcomes of patients taking daily aspirin with those of unmedicated controls. Ninety patients who were 50 years of age or older and taking 81 mg or 325 mg daily aspirin were matched to 90 controls. Patients were matched on age, surgery type, and the use of a tourniquet. A complication was defined as bleeding, wound dehiscence, or wound infection requiring reoperation. Postoperative outcome measures including hematoma formation, extent of ecchymosis (mm), visual analog scale (VAS) scores for pain and swelling, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and postoperatively (10-14 days and 4-6 weeks). Results: There were no complications (0%) in either cohort. There was no difference in hematoma formation (aspirin, 1.8%; controls, 2.4%; P = .79), incidence of ecchymosis (aspirin, 17%; controls, 21%; P = .70), or the average extent of ecchymosis (aspirin, 124.6 mm; controls, 80.3 mm; P = .36) between patients taking aspirin and controls. There was no significant difference in pre- or postoperative knee range of motion between controls and patients taking aspirin. The KOOS subscores and VAS pain scores were similar between patients taking aspirin and controls at baseline and at follow-up. Conclusion: The perioperative continuation of daily aspirin in patients 50 years of age and older undergoing arthroscopic procedures of the knee is safe and does not result in an increased rate of bleeding or wound complications requiring reoperation. Continued aspirin use in patients 50 years of age and older had no significant effect on postoperative physical examination measures or patient-rated outcome scores.

scholarly journals Comparison of Clinical Results Between a 4-point Scleral Fixation of Intraocular Lenses Using Gore-tex Suture and a 2-point Fixation Using Prolene Suture

2022 ◽  
Author(s):  
Jeong Mo Han ◽  
Dong Min Cha ◽  
Hee Chan Ku ◽  
Dong Kwon Lim ◽  
Eun Koo Lee ◽  
...  
Keyword(s):  
Surgical Complication ◽  
Good Alternative ◽  
Clinical Results ◽  
Intraocular Lenses ◽  
Complication Rates ◽  
Scleral Fixation ◽  
Average Prediction Error ◽  
Refractive Outcomes ◽  
Significant Difference ◽  
Prolene Suture

Abstract Purpose: To compare clinical outcomes between a 4-point scleral fixation of intraocular lenses (IOLs) using Gore-Tex suture or a 2-point scleral fixation using Prolene sutureMethods: In this multicenter, retrospective cohort study, patients were enrolled who had undergone a pars plana vitrectomy and either a 4-point scleral fixation using Gore-Tex suture or a 2-point scleral fixation using Prolene suture. Preoperative biometrics, postoperative refractive outcomes, and postoperative surgical complication rates were evaluated.Results: Thirty-seven eyes underwent scleral fixation with Gore-Tex suture, while 44 eyes underwent scleral fixation with Prolene suture. Postoperative best corrected visual acuity was 0.20 (± 0.34) in the Gore-Tex group and 0.21 (± 0.28) in the Prolene group (logMAR, 20/32 on the Snellen scale) (p = 0.691). No significant difference was found in the average prediction error between the Gore-Tex (-0.13 ± 0.68 D) and Prolene (-0.21 ± 1.27 D) groups (p = 0.077). The postoperative complication rate was lower in the Gore-Tex group (17%) than in the Prolene group (41%) (p = 0.023).Conclusion: A 4-point scleral fixation using Gore-Tex suture may be a good alternative to a conventional scleral fixation using Prolene suture for IOL implantations in eyes without capsular support, with a lower risk of postoperative complications.

scholarly journals Do different surgical techniques in tibia pilon fractures change the results of the midterm?

2020 ◽  
Vol 50 (6) ◽  
pp. 1559-1565
Author(s):  
Vedat BİÇİCİ ◽  
İzzet BİNGÖL
Keyword(s):  
Surgical Techniques ◽  
Functional Results ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Pilon Fracture ◽  
Significant Difference ◽  
One Step ◽  
Type 3 ◽  
Pilon Fractures

Background/aim: Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques.Materials and methods: 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated.Results: The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004).Conclusion: Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.

scholarly journals Mapping of Posterior Talar Dome Access through Standard Posteromedial and Posterolateral Approaches With or Without an External Fixator Distraction: A Match-paired Cadaveric Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Graham J. DeKeyser ◽  
Yantarat Sripanich ◽  
Jesse Steadman ◽  
Chamnanni Rungprai ◽  
Justin Haller ◽  
...  
Keyword(s):  
Surface Area ◽  
External Fixator ◽  
Kirschner Wire ◽  
Fracture Repair ◽  
Cadaveric Study ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Talar Dome ◽  
Significant Difference ◽  
Accessible Area

Category: Trauma; Ankle; Other Introduction/Purpose: Posterior talar body fractures (AO/OTA 81.1.B/C) are rare injuries that present unique challenges in their access to the treating surgeon. Accessibility to this structure has been investigated extensively in the context of osteochondral lesion interventions, normally requiring perpendicular access to perform operative procedures. However, techniques in gaining this access regarding fracture repair, requiring only adequate visualization, has not been described in literature. Generally, a pre-operative decision is made between a posterior, soft-tissue based approach or a peri-articular osteotomy, which is associated with comparatively higher morbidity and complication rates. The aim of this study is to evaluate the accessible area of the talar dome via two standard posterior approaches (posteromedial; PM, and posterolateral; PL) with and without external fixator distraction. Methods: Eight male through-knee matched-paired cadaveric legs (mean age: 49.0 +- 14.6; mean BMI: 24.5+- 3.9 kg/m2) were included in this study. A standard PM or PL approach was performed using a randomized crossover design for surgical sequences. The accessible area without distraction was initially outlined by drilling a 1.6-mm Kirschner wire around the periphery of the visualized talus. Five millimeters of distraction, confirmed with fluoroscopy, was then applied to the specimens using an external fixator. The accessible area was again marked using the same method. The tali specimens were then explanted and imaged using a Micro-CT scanner to acquire 3 dimensional reconstructions. The accessible area was calculated as a percentage of the total talar dome surface area. The Mann-Whitney U test was used to compare the reported areas among the two surgical approaches, where the Wilcoxon signed rank test was utilized to compare values among distracted and non-distracted conditions. Results: In reference, the average total surface area of the talus is 16.94 +- 2.47 cm2. No statistically significant differences were found among match-paired specimens (p=0.63). The PM approach allowed access to 17.1% (11.1 to 23.6%, SD 5.4) of the talar dome surface without distraction and 29.3% (20.0 to 38.6%, SD 8.6) of the talar dome surface with distraction. The PL approach provided access to 7.4% (4.7 to 11.8%, SD 3.1) and 17.0% (11.0 to 26.1%, SD 6.5) of the talar dome surface with and without distraction, respectively. A statistically significant difference was observed in talar dome accessibility among distracted and non- distracted conditions in both surgical approaches (p=0.008). Additionally, the PM approach provided significantly more access to the talar dome relative to the PL approach (p=0.043). Conclusion: This matched-paired cadaveric study provides roadmap that can assist in the pre-operative planning of talar dome access in the treatment of talar body and posterior tubercle fractures. We found no advantage to a PL approach over a PM approach to access these challenging fractures. Additionally, added distraction using an external fixator consistently increased visualization of the talar dome by a magnitude of at least 40% greater than the non-distracted conditions. These methods can be applied clinically to gain appropriate access to the talar dome, allowing fracture repair.

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