Temporary Transarticular Screw Fixation for Traumatic Peritalar Instability After Talar Fracture-Dislocation.

Background: Traumatic peritalar instability following talar fracture-dislocation is a complex surgical challenge with no consensus on adjunctive stabilization. Current strategies can involve extensive soft tissue dissection or external fixation. We report a retrospective case series evaluating temporary transarticular screw fixation as an adjunct to open reduction and internal fixation (ORIF). Methods: We conducted a retrospective case series of 9 patients (10 extremities) treated at a single tertiary institution between 2015 and 2024 for traumatic peritalar instability persisting after ORIF. After primary ORIF of the talus, persistent subtalar instability was addressed with one or two 4.0-mm cortical screws placed across the subtalar joint. Screws were removed after radiographic evidence of fracture union. Primary outcomes were resolution of instability judged by intraoperative resolution of dislocation/subluxation with maintenance of joint congruity to injury resolution. Secondary outcomes were incidence of complications, including avascular necrosis (AVN) and posttraumatic arthritis (PTA). Results: The cohort included 9 patients (mean age 37 years) with a mean follow-up of 27 months. All 10 operative extremities achieved full resolution of peritalar instability. Three extremities required subsequent arthrodesis because of PTA and/or AVN. Two extremities developed AVN, with 2 of the 3 arthrodeses following AVN development. One patient did not have the transarticular screw removed because of articular surface damage at the time of index injury. Three extremities developed infections: 2 superficial infections resolved with oral antibiotics, and 1 deep infection necessitated tibiotalar and subtalar arthrodesis using an antibiotic-coated intramedullary nail due to osteomyelitis, with infection resolution and return to activity. Nine extremities exhibited some form of PTA in the peritalar articulations. Four of 10 patients underwent Achilles tendon lengthening for contracture. Eight of 9 patients returned to unprotected weightbearing and full activity at the most recent follow-up; 6 resumed work and could perform a double-leg heel rise, and 2 required bracing. Conclusion: Temporary transarticular screw fixation appears safe in this limited series and effective for resolving traumatic peritalar instability. The observed AVN rate (20%) is lower than many published series but should be interpreted cautiously given the small sample size. PTA rates remain high but are consistent with the expected results because of the severity of the initial injury. This technique may serve as a valuable, minimally invasive adjunct in the management of complex talar trauma. Level of Evidence: Level IV, retrospective case series.