A 39-year-old man who was a carpenter complained of right hindfoot pain after he fell from a stepladder during work. At the first visit to our hospital, he could not walk due to his right hindfoot pain. Physical examination revealed swelling, ecchymosis, and tenderness at the posterior aspect of his ankle. Plain radiographs of the right ankle showed no abnormal findings in anteroposterior and lateral views (Figure 1). Noncontrast computed tomography (CT) demonstrated a fracture line from the lateral side of the posterior lateral process to the medial side of the talus body. In addition, the fracture line extended to the posterior ankle and subtalar joints, and the bone fragment was slightly displaced (Figure 2). Based on the physical examination and radiological findings, the diagnosis of the talar body fracture was made. Because of the displaced bone fragments from the fracture, surgical treatment was applied for this case.
The surgery was performed under general anesthesia in the prone position. A thigh air tourniquet and a fluoroscopy were used. Based on the hindfoot endoscopic technique reported by van Dijk et al., posterolateral and posteromedial portals were created. The posterolateral portal was used as a viewing portal, and the posteromedial portal was used as a working portal for the motorized shaver and guide wires. First, the posterior aspect of the talus was observed using a 4.0-mm-diameter 30  arthroscope. Soft tissues around the talus including synovium, adipose tissue, and coagulation clot were removed with a 4.0-mm-diameter motorized shaver, and the fragment was easily reduced using a guidewire sleeve and fixed with two 0.8 mm guidewires. A lateral view of the ankle joint was visualized by a fluoroscopy in the prone position, and we confirmed the guidewires in an adequate position and the alignment after the reduction of the bone fragment. Through the guidewires, the fragment was fixed with two cannulated double-threaded screws (Double Thread Screw Japan Mini, Meira, Nagoya, Japan) (Figure 3). The wound was sutured, and the surgery was concluded (Figure 4).
Postoperatively, a nonweightbearing short leg splint was applied for 2 weeks, and when the splint was removed, active and passive ranges of motion exercises of the ankle were initiated. Partial weightbearing was allowed at 6 weeks postoperatively, and full weightbearing at 10 weeks postoperatively. The patient was permitted to return to work after confirming consolidation of the fracture site on CT at 14 weeks after the operation (Figure 5). At 2 years after surgery, he was able to work as a carpenter without any complications nor symptoms, and the AOFAS score was 97.