Anatomical study of surgical approaches to the talus. / Estudio y descripción anatómica de vías de abordaje del astrágalo.

Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction.

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy. / Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles.

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.