Surgical technique
EXSANGUINATION
A preoperative antibiotic was given at the induction of the anesthesia. The supine position was used, with a bump under the ipsilateral hip to rotate the leg internally on a translucent table so that fluoroscopy could be used intraoperatively. After exsanguination, a pneumatic tourniquet was inflated to 350 mmHg. The sinus tarsi approach [The reduction of the articular surface was evaluated by using the articular surface of the talus as a template for the reduction, in addition to intraoperative fluoroscopy. Then the reduction was stabilized using one or more trans-articular KWs from the calcaneum to the talus. The reduction and KW positions were then evaluated using lateral, Harris axial and broaden views [Intraoperative images. At the end of the procedure, the tourniquet was released with appropriate hemostasis. In cases where a bone void was found, it was packed with a gel-foam roll. The wound was closed in layers. The KWs were cut approximately 1 cm out from the skin and dressed with protective gauze dressings, and the leg was held in a below-knee back slab. Sutures were removed after 2 weeks, and a below-knee cast was applied for a further 4 weeks. The KWs and cast were removed after 6 weeks from surgery; then range of motion and toe-touch weight bearing was allowed till the end of the third month postoperatively.