Talar Neck Research Articles

Pathological and normal variability of foot bones in osteological collections from Catalonia (Spain) and Lazio (Italy)

A wide number of factors can affect the structure of the bones in the foot. In bioarchaeology, few studies about foot anomalies include population comparisons and changes across time. We aimed to identify normal and pathological variability that affected the foot in the recent history of West Mediterranean populations. Thus, we analyzed change in occurrence of rare variants, pathological lesions, entheseal morphology, and their probable causes. We studied 518 pairs of skeletonized feet dated from the 2nd–20th centuries CE, from Catalonia (Spain) and the region of Lazio (Italy). Moreover, a Neolithic series from Oman has been analyzed for contrast. We found that calcaneal spur, hypertrophic peroneal trochlea of calcaneus, periosteal reaction of talar neck, alteration of articular surface to lateral cuneiform, displaced talar neck to medial plane, osteophytes in cuneiform-navicular joint, fused phalanges, and forefoot eburnation showed significant differences among countries. Contrasting by countries and dates, we noticed an increase in the frequencies of these variables from Spain over the centuries. Conversely, there are no temporal differences among the Italian series. The period encompassing the 10th–19th centuries CE demonstrated the highest differences between countries. Lifestyle, occupations, footwear, and geography could be the origin of variability.

Union Rates of Talar Neck Fractures With Substantial Bone Defects Treated With Autograft

This study evaluated the union rate of talar neck fractures with substantial bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. A case series at a level 1 trauma center was performed to identify consecutive patients who underwent operative fixation of talar neck fracture with autograft (Current Procedural Terminology codes 28445 and 20902) between 2015 and 2018. "Substantial bone defect" was defined as a gap greater than 5 mm in the sagittal plane and greater than one-third of width of the talar neck in the coronal plane. Postoperative foot computed tomographic (CT) scans were obtained for all patients. Primary outcome was union, and secondary outcomes were malunion, avascular necrosis (AVN), post-traumatic arthritis (PTA), and patient-reported outcomes (PROs). Twelve patients with 12 fractures were included in the series, with an average length of follow-up of 26 months (range: 7-55) The average age was 34 years (17-59), and the most common mechanism of injury was motor vehicle crash. The Hawkins classification of the fractures was 4 type II (2 type IIA and 2 type IIB) (33%) and 8 type III (67%). Four fractures (33%) were open fractures. Union was achieved in 11 patients (92%). There was 1 malunion (8%). AVN was identified on postoperative CT scans in 11 patients (92%). Three of these 11 eventually showed collapse. Ten patients (83%) had radiographic evidence of some degree of ankle PTA, and 12 patients (100%) had radiographic evidence of some degree of subtalar PTA. Average Patient-Reported Outcomes Measurement Information System-Short Form score was 37 (32-45) and average Foot and Ankle Ability Measure activities of daily living and sports subscale scores were, respectively, 61 (31-87) and 31 (0-71), respectively. Average visual analog scale score was 5 (0-10), and average Foot Function Index was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients. In this relatively small series, tibial autograft in primary osteosynthesis of comminuted talar neck fractures with substantial bone defects is associated with excellent union rates and low malunion rates. Despite high union rates, secondary outcomes of AVN with or without collapse, ankle and subtalar PTA, and relatively low PROs were common. Level IV, case series.

Spatial structure of talus trabeculae based on high resolution X-ray and micro-CT

Objective: To study the specific alignment and structure of cancellous bone within the talus in order to understand the mechanism of force transmission within the bone and to provide some theoretical basis for the repositioning of talar fractures and the design of prostheses. Methods: In January 2020, a total of 40 adult talar bone specimens were scanned by Micro-CT in 20 pairs obtained from the Department of Orthopedics of Tianjin Hospital. The bone volume fraction, bone surface area fraction, trabecular thickness, number of trabeculae, trabecular pattern factor of the head, neck and body of the talus were calculated, and the differences in each parameter were compared between different parts of the same side and different sides of the same part, respectively. The talus was cut into 2 mm thick slices in the coronal, sagittal and horizontal planes using a hard tissue slicer, and the slices were then scanned using high-resolution X-rays to describe the bone structure. Results: There were no statistically significant differences between the medial and lateral talar and right and left side in lateral trabecular bone volume fraction, bone surface area fraction, trabecular thickness, trabecular number, trabecular pattern factors (all P>0.05). The number of trabeculae in the talar head, neck and body was 1.608±0.150, 1.639±0.142 and 1.749±0.159, respectively; trabecular thickness (μm) in the talar head, neck and body was 0.378±0.054, 0.370±0.053 and 0.331±0.062, respectively; and the trabecular pattern factors (mm-1) in the talar head, neck and body was -0.407±0.699, -0.478±0.848 and -1.029±0.851, respectively. There were significant differences between talar head, neck and the talar body trabeculae in terms of the number of trabeculae, trabecular thickness,trabecular pattern factor parameters(all P<0.05). The structure of the talar body trabeculae was found to consist of plate trabeculae arranged vertically parallel to each other in the coronal, sagittal and horizontal planes. The talar neck trabeculae were twisted, external-superior to internal-inferior reticular plate structure that travelled posteriorly and anteriorly, and the talar head trabeculae consisted of similarly parallel aligned semi-arc-shaped external-superior and internal-inferior trabeculae. Conclusion: The talar trabeculae are clearly directional and functional, so anatomical reduction should be achieved after the fracture; at the same time, the design of the talar prosthesis should take into account the stress distribution and direction of the prosthesis during walking and standing.

Functional and radiological outcome of closed talus neck fractures managed by open reduction and internal fixation: A case series study

Background and Objectives: Displaced talar fractures remain a therapeutic challenge for orthopaedic surgeons. According to the literature, these fractures are often associated with high complication rates, including malunion, osteonecrosis, osteoarthritis. The operative treatment of such fractures seems to require a balance between an aggressive treatment with a strict anatomical reduction and essential respect of soft tissues to limit skin complications or osteonecrosis. Fractures of the talus are known to be relatively uncommon. Talus fractures comprise approximately 0.1 to 0.85 percent of all fractures. Most occur as a result of high-energy trauma, such as motor vehicle accidents. As a result, talus fractures are often accompanied by other injuries, including dislocation of adjacent joints and fracture of neighboring bones. However, due to the relatively better diagnostic methods introduced more talar fractures have been recognized and it remains the second most common tarsal bone to get fractured after calcaneum. Methods: 30 patients were selected in an age group of 15-60 years who suffered from closed talus fractures either by road traffic accidents or fall injuries. After clinical evaluation and investigations, Xray and CT scan of ankle of patients were done. The patients underwent operative fixation of talus fracture by cancellous screw fixation and post-operative immobilization was given. Following discharge, patients were followed up at 3rd month, 6th month, 1 year, and during each follow up serial Xrays were taken anteroposterior, lateral, mortise view of the ankle joint. Clinical assessment of the ankle was done using Baird Jackson score, Olerud Molander, AOFAS scoring. clinical complaints of pain and inability to walk and undergo daily activities along with gait abnormalities.8 out of these 10 cases had joint incongruity and ankle joint pain and restriction of movement signifying arthritic changes. 2 cases had non-union seen at 3rd month post-op Xray and were advised and put on below-knee cast and immobilization for 8 weeks. In all cases, cancellous screws were used as the implant of choice and no implant-related complications were found in any of the patients. There was no post-operative skin infection or skin necrosis seen in any patients. Conclusion: Open reduction and internal fixation are recommended for the treatment of displaced talar neck and/or body fractures. A delay in surgical fixation does not appear to affect the outcome, union, or prevalence of osteonecrosis, rather the type of fractures that might be indirectly influenced by the mechanism of injury provides a statistical significance.

A case series: Talus neck fractures treated with open reduction and internal fixation with dual approach- anteromedial and anterolateral

Background: Talus neck fractures are rare but potentially devastating injuries, which require a comprehensive understanding of it’s anatomy, blood supply, fracture classification and management.Materials and Methodology: This was a prospective study of 8 cases of closed displaced talus neck fractures, managed at Sheth L.G. hospital. We used Modified Hawkins classification to classify fracture pattern, treatedwith open reduction internal fixation and outcome was evaluated with help of two parameters: functional and radiographical.Results: We found an average score of 81 points out of 100 (good) using AOFAS Ankle-hindfoot scale after 1 year follow-up. While two out of eight patients developed osteonecrosis of talus which was visible in their 1 year follow up x-rays.Conclusion: We can conclude that dual approach- antero-medial and antero- lateral to the displaced talus neck fracture, allows full visualization of the fracture and anatomical reduction, which results in good functional outcome.

Intelligent localization and quantitative evaluation of anterior talofibular ligament injury using magnetic resonance imaging of ankle

BackgroundThere is a high incidence of injury to the lateral ligament of the ankle in daily living and sports activities. The anterior talofibular ligament (ATFL) is the most frequent types of ankle injuries. It is of great clinical significance to achieve intelligent localization and injury evaluation of ATFL due to its vulnerability.MethodsAccording to the specific characteristics of bones in different slices, the key slice was extracted by image segmentation and characteristic analysis. Then, the talus and fibula in the key slice were segmented by distance regularized level set evolution (DRLSE), and the curvature of their contour pixels was calculated to find useful feature points including the neck of talus, the inner edge of fibula, and the outer edge of fibula. ATFL area can be located using these feature points so as to quantify its first-order gray features and second-order texture features. Support vector machine (SVM) was performed for evaluation of ATFL injury.ResultsData were collected retrospectively from 158 patients who underwent MRI, and were divided into normal (68) and tear (90) group. The positioning accuracy and Dice coefficient were used to measure the performance of ATFL localization, and the mean values are 87.7% and 77.1%, respectively, which is helpful for the following feature extraction. SVM gave a good prediction ability with accuracy of 93.8%, sensitivity of 88.9%, specificity of 100%, precision of 100%, and F1 score of 94.2% in the test set.ConclusionExperimental results indicate that the proposed method is reliable in diagnosing ATFL injury. This study may provide a potentially viable method for aided clinical diagnoses of some ligament injury.

English

BACKGROUND Talus is a very important bone among the skeleton of foot. Talus is a very common bone which undergoes some structural modifications due to prolonged habitual squatting postures. Structural alterations like squatting facets, trochlear extensions are observed over the dorsal aspect of the neck of the talus common type of squatting facets observed are medial squatting facets, lateral squatting facets, combined type of squatting facets .These are observed in specific group of people. METHODS Present study was conducted in 100 talus bones, which are procured from department of Anatomy, Andhra medical college, Visakhapatnam. Structural modifications like squatting facets, trochlear extensions are studied in all the bones. RESULTS Squatting facets are observed in most of the talus .but trochlear extensions are not observed in any of the talus .out of 100 talus, 54 tali are having lateral squatting facet, 4tali are having a medial squatting facet, 16 tali showing combined type of squatting facet, 26 tali are not having any type of squatting facets. Out of 54 right sided taluses, 24 tali are having a lateral squatting facet, 3 tali are having medial squatting facet, 10 tali are having combined type of squatting facet, 17tali are not having any type of squatting facet. Out of 46 left sided taluses, 30tali are having lateral squatting facet, 1 talus is having a medial squatting facet, 6 tali are having combined type of squatting facets, 9tali are not having any type of squatting facet. CONCLUSIONS Incidence of modifications over the neck of talus is very common in people who are having a rural background, those people are having a habitual squatting position. And these alterations may be due to genetic inheritance and several unexplainable reasons. KEYWORDS Talus, Squatting Facet, Habitual Squatting Posture, Lateral Squatting Facet, Medial Squatting Facet

Conservative and Surgical Treatment of Talar Fractures: A Systematic Review and Meta-Analysis on Clinical Outcomes and Complications.

The integrity of the talus is crucial for the physiologic function of the feet. The present study sought to summarize the available evidence on clinical outcomes and complications following conservative and surgical treatment of talar fractures. We systematically searched Medline via OVID to find relevant studies with a follow-up of at least six months. Hereafter, the success and complication rates were extracted and analyzed in a random effects proportion meta-analysis. Complications were defined as avascular bone necrosis (AVN) and posttraumatic osteoarthritis (OA). Additionally, a subgroup analysis was performed for fracture localization (talar neck fractures (TN) and combined talar body/neck fractures (TN/TB)) and severity of the fracture. The quality of the included studies was assessed utilizing the Coleman Methodology Score (CMS). A total of 29 retrospective studies, including 987 fractures with a mean follow-up of 49.9 months, were examined. Success rates were 62%, 60%, and 50% for pooled fractures, TN, and TN/TB, respectively. The overall complication rate for AVN was 25%. The rate was higher for TN (43%) than TN/TB (25%). Talar fractures revealed a 43% posttraumatic osteoarthritis (OA) rate in our meta-analysis. Success rates showed an association with fracture severity, and were generally low in complex multi-fragmentary fractures. The mean CMS was 34.3 (range: 19–47), indicating a moderate methodological quality of the studies. The present systematic review on clinical outcomes of patients undergoing conservative or surgical treatment for talar fractures reveals a lack of reliable prospective evidence. Talar fractures are associated with relatively poor postoperative outcomes, high rates of AVN, and posttraumatic osteoarthritis. Poor outcomes revealed a positive association with fracture severity. Prospective studies investigating predictors for treatment success and/or failure are urgently needed to improve the overall quality of life and function of patients undergoing surgical treatment due to talar fractures.

Sufficient Cartilage for Most Talar Articular Defects Can Be Harvested From the Non–Loadbearing Talus: A Cadaveric Analysis

PurposeTo assess the quantity of morselized cartilage that can be harvested from the non–load-bearing portion of the talus for immediate reimplantation.MethodsNon–load-bearing talar cartilage was harvested from 5 cadaveric specimens using a standard arthroscopic approach. Cartilage was separated from the talus in maximum dorsiflexion at the junction of the talar head and neck, grasped, and morselized into a graft using a cartilage particulator. The volume of reclaimed cartilage was measured, and the extrapolated area of coverage was compared to average osteochondral lesions of the talus previously reported.ResultsThe total yield of cartilage graft following processing that was obtained from 5 ankle joints ranged from 0.3 mL to 2.1 mL with a mean volume of 1.3 ± 0.7 mL, yielding a theoretical 13.2 ± 7.1 cm2 coverage with a 1-mm monolayer. While the average size of osteochondral lesions of the talus is difficult to estimate, they may range from 0.5 cm2 to 3.7 cm2 according to the literature.ConclusionsThis study validated that it is possible to harvest sufficient amount of cartilage for an autologous morselized cartilage graft via a single-stage, single-site surgical and processing technique to address most talar articular cartilage defects.Clinical RelevanceParticulated cartilage autografts have shown promise in surgical management of cartilage defects. A single-site, single-staged procedure that uses a patient’s autologous talar cartilage from the same joint has the potential to reduce morbidity associated with multiple surgical sites, multistaged procedure, or nonautologous tissue in ankle surgery.

Different patterns and characteristics of Talar injuries at two main orthopedic trauma centers in Shiraz, south of Iran

BackgroundCategorizing different injury patterns of the talus, describing demographic data, mechanisms of injury and associated fractures are important issues in orthopedic trauma surgeries. Injuries of the talus require careful attention with appropriate treatment approaches in order to reduce possible complications.MethodsIn a cross-sectional study, the demographic characteristics, mechanism of injury, fracture type, and associated fractures were compiled from all patients’ files and operation notes with diagnosis of talar injuries from January 2014 to December 2019.ResultsAmong 367 patients, 317 (86.4%) males and 50 (13.6%) females with mean age of 31.8 ± 11.6 years were identified. There were three (0.8%) patients with bilateral talar fractures. The most common mechanism of injury was motor vehicle accident (MVA) (46.1%), followed by falls (43.3%), direct trauma (6.2%) and sport injuries (4.4%). About half of the patients injured in MVAs were motorcyclists. Isolated talar body fractures (21.9%) were more common than isolated talar neck (19.2%) or combined body & neck fractures (14.6%). Isolated lateral process fracture is the most frequent fractured process of the talus (14.3%). Hawkin type IIA (39.2%) was the most common type of talar neck, followed by Hawkin type III (22.3%), type I (21.5%), type IIB (14.6%) and type IV (2.3%). Medial malleolus, fibula and calcaneus were the most common associated fractures, respectively.ConclusionsThe population that is most affected by talar injury are active young men who are involved in motor vehicle accidents, especially motorcycle crashes, with fracture of body and/or neck of talus being the most common type.

Evaluation of open reduction and internal fixation in closed fracture of talus: Seven -year observational study

Background: But because of the unique anatomical shapes and the vascular anatomy of the talus bone fracture of it is most challenging injury to manages. Despite the development in the field of diagnostics and improvement is surgical procedure, the complication is still frequent. As there is variability in the outcome of management of talus present study has been done to evaluate the outcome of open reduction and internal fixation in closed fracture of talus in our clinical scenario. Method: Patients with fracture of talus admitted in the department of orthopaedics and trauma are enrolled for this study based on inclusion and inclusion criteria. Patient were evaluated both radiologically in anteroposterior, lateral, and mortise radiographs at two weeks, six weeks, twelve weeks, and six months postoperatively and clinically as well. All patients were followed upto two year and clinical evaluation done by AOFAS is a clinician-reporting tool. Result:Among patients with type 2 fracture of neck of talus one has developed post-operative wound infection, one has developed post traumatic arthritis and two developed avascular necrosis. Among patients with type 3 fracture of neck of talus, two have developed post traumatic arthritis and two developed avascular necrosis. Among patients with type 4 fracture of neck of talus one has developed post-operative wound infection, and two developed avascular necrosis. Discussion and Conclusion:From present study we can conclude that fracture of talus is uncommon with male predominance. Fracture of neck of talus is more common than body. Anteromedial and anterolateral approach was commonly used in surgical treatment. Avascular necrosis was common in type 4 fracture of neck of talus and post traumatic arthritis was found in type 3 fracture. As per ankle hindfoot scale clinical outcome fair and good outcome was equally found and 25% patient have poor outcome.

Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation–systematic review and meta-analysis

To provide a direct comparison between two important aspects related to talar neck fractures management - surgical approaches and fixation strategies. A systematic review and meta-analysis was performed using PubMed, SciELO, and gray literature databases. The keyword "talus fracture" and the combined terms "talus neck fracture AND surgical approach" and "talus neck fracture AND fixation strategy" were used. Study selection, data extraction, and the risk of bias assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were limited to human studies and the English and Portuguese. Inclusion criteria were articles in full text that reported on any aspect of surgical approach and fixation strategy for talus neck fractures. Exclusion criteria were skeletally immature patients, mean follow-up of less than 12 months, studies that did not use the Hawkins classification system, primary treatment of arthrodesis, studies published before year 2000, and studies published in languages other than English and Portuguese. Basic information was collected including journal, author(s), year published, level of evidence, number of fractures, and follow-up. Specific information was collected including fracture classification, surgical approach, fixation strategy, complication rate, type of complication(s), and outcome measurement(s). Fixed-effects model was used for meta-analysis. The choice for surgical approach(es) and fixation strategy was stratified based on fracture classification. Complication rate, type of complication(s), and outcome measurement(s) were calculated for all studies and delineated by fracture classification. There is a significant correlation between poor scores and poor fracture reduction, but not with the modified Hawkins classification, surgical approach, and fixation strategy. The presence of an open talus neck fracture-dislocation jeopardizes the functional outcome, increasing the risk of complications. The overall avascular necrosis and post-traumatic osteoarthritis event rate was 0.279 and 0.400, respectively. Both complications were highly correlated to higher energy fracture patterns and to the use of combined approaches, but not to fixation strategy. I (systematic review and meta-analysis).

Magnetic resonance imaging of severe idiopathic club foot treated with one-week accelerated Ponseti (OWAP) technique

PurposeThis study aims to evaluate changes in tarsal bones relationship after the use of one week accelerated Ponseti method in the treatment of severe idiopathic clubfoot using MRI. We hypothesize that one-week accelerated Ponseti is at least as effective as standard techniques in achieving the desirable MRI parameters. MethodsThis is a prospective study of 8 children with severe idiopathic clubfeet (Pirani 6) (4 unilateral and 4 bilateral) treated before the age of three months with one-week accelerated Ponseti technique, as described in a former study with minimum 2-year follow-up. The 8 corrected feet were compared with the 4 unilateral normal feet at clinical and radiological levels using a Pirani scoring system and an MRI, respectively. ResultsClinical results showed that Pirani score was 1.1 in the last follow up in comparison to Pirani 6 pretreatment (p < 0.05). MRI results indicated that the malleocalcaneal angle, axial malleocalcaneal index, coronal tibiocalcaneal angle, sagittal talocalcaneal angle, and talar head neck calcaneal rotation showed statistical difference between the two groups (p < 0.05). Sagittal malleocalcaneal index, sagittal tibiocalcaneal angle, talar head neck rotation related to talar body, and posterior calcaneal rotation showed no statistical difference between normal feet and clubfeet after correction (p value >0.05). ConclusionOne-week accelerated Ponseti technique showed to be as effective and safe as other treatment methods through clinical and MRI follow up data. MRI role was to confirm the efficiency of this innovative accelerated technique, but not used as a routine follow up.

Antiresorptive treatment and talar collapse after displaced fractures of the talar neck: a long-term follow-up of 19 patients

Background and purpose — Displaced fractures of the talar neck are associated with a high risk of structural collapse. In this observational analysis we hypothesized that pharmacological inhibition of osteoclast function might reduce the risk of structural collapse through a reduction in bone resorption during revascularization of the injured bone. Patients and methods — Between 2002 and 2014 we treated 19 patients with displaced fractures of the talar neck with open reduction and internal fixation. Of these, 16 patients were available for final follow-up between January and November 2017 (median 12 years, IQR 7–13). Among these, 6 patients with Hawkins type 3 fractures and 2 patients with Hawkins type 2b fractures received postoperative antiresorptive treatment (7 alendronate, 1 denosumab) for 6 to 12 months. The remaining 8 patients received no antiresorptive treatment. The self-reported foot and ankle score (SEFAS) was available in all patients and 15 patients had undergone computed tomography (CT) at final follow-up, which allowed evaluation of structural collapse of the talar dome and signs of post-traumatic osteoarthritis. Results — The risk for partial collapse of the talar dome was equal in the 2 groups (3 in each group) and post-traumatic arthritis was observed in all patients. The SEFAS in patients with antiresorptive treatment was lower, at 21 points (95% CI 15–26), compared with those without treatment, 29 points (CI 22–35). Interpretation — Following a displaced fracture of the talar neck, we found no effect of antiresorptive therapy on the rate of talar collapse, post-traumatic osteoarthritis, and patient-reported outcomes.

A study on functional outcome of Talar fractures

Background: Talar fractures are second in frequency among all tarsal bone fractures. Two percent of all lower extremity injuries and 5% to 7% of foot injuries involve fractures of the talus. The role of the talus in lower extremity function, the complexity of the anatomy, and the variability of fracture patterns often complicate treatment of talar fractures and often frustrate orthopaedic surgeon. The primary goal of treatment is to obtain stable, pain free subtalar and ankle joints and restoration of their maximum function. Aim: To study about the functional outcome of talus fracture following internal fixation by using cannulated cancellous screws. Materials and Methods: 20 patients [11males and 9 females] admitted in government thoothukudi medical college hospital thoothukudi with ankle injuries with talus fractues were included in this study. All the patients were treated with internal fixation with cannulated cancellous screw fixation. Patients were followed up and assessed for functional outcome with AOFAS scoring and Hawkins grading criteria. Results: 20 patients with talar fractures admitted at Government Thoothukudi medical college hospital, Thoothukudi were included in the study. All the patients were treated with internal fixation with cannulated cancellous screws. The longest follow up period was 18 months and shortest follow up period was 6 months, mean follow up period was 12 months. Follow up analysis was made using AOFAS scoring and Hawkins grading criteria. In our study, 65% of patients were less than 30 years of age. 70% of patients were male and there was no significant difference in the side affected (right-9, left-11). Most of the patients sustained injury by fall from height (55%). 55% of patients had fracture of neck of talus among others. In this study, 40% of patients had excellent outcome, 30% patients had good outcome and 30% had fair outcome, while none had poor outcome. In this study, only 1 patient developed screw prominence and wound infection, treated with IV antibiotics, and screw removal done. One patient developed avascular necrosis of the talus and one another developed subtalar arthritis, both of them were treated with subtalar arthrodesis. Conclusion: In conclusion, treatment of fracture of talus with closed / open reduction and screw fixation facilitated early mobilization of the patients and helped achieving stable, pain free subtalar and ankle joints and preventing avascular necrosis of talus and subtalar and ankle joint arthritis.

Surgical Outcomes of Articular Surface Crush Injury of Hawkins Ⅲ Talus Neck and Medial Malleolus Fracture

<h2>ABSTRACT</h2> The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (<i>p</i> < .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores > 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.

Quantitative MRI Analysis of the Talocrural and Talonavicular Joints in Ballet Dancers.

The ankles of ballet dancers are routinely under heavy loading that may lead to osteoarthritic changes. It would be clinically useful to identify such pathology as early as possible in a dancer's career. Therefore, the purpose of this study was to compare quantitative measurements in magnetic resonance (MR) images of the talocrural and talonavicular joints in ballet dancers and healthy non-dancers for use in formulating prediction of chronic injury and degenerative joint disease in these locations. Quantitative measurements in MR images of the talocrural and talonavicular joints were compared in 10 female ballet dancers, 10 healthy female non-dancers, and nine male ballet dancers. Fat-suppressed density-weighted proton, T1rho, and T2 mapping images were acquired with a 3.0 T MR scanner. Medial and lateral subchondral bone distance between the tibia and talus (MSBD and LSBD), axial navicular-talus axis angle (ANT angle), sagittal talar neck angle against the posterior talocalcaneal joint (TN angle), and curvature of navicular surface at the talonavicular joint were measured on sagittal images. The medial subchondral bone distance was found to be significantly larger in female dancers than female non-dancers (4.05 mm vs. 2.75 mm, p < 0.05), whereas there were no significant differences in LSBD (2.63 mm vs. 2.63 mm, p = 0.87). Axial navicular talus angles in female dancers were significantly larger than those in female non-dancers (38.9° vs. 24.3°, p < 0.05). There was a tendency for the TN angle to be smaller and navicular curvature (NC) to be larger in female dancers compared to female non-dancers, though the differences were not significant (TN angle: 16.6° vs. 22.3°, p = 0.09, and NC: 0.186 vs. 0.165, p = 0.28). There were no significant differences in T1rho or T2 values of talonavicular joint cartilage. These results show that the bony anatomy of dancers' ankles may adapt to the stresses placed on them by ballet.

The avascular necrosis after talar neck fractures. Risk factors and Outcomes

The avascular necrosis after talar neck fractures. Risk factors and Outcomes

An anatomical study on types of calcaneal facets on talus and co relation between squatting facets and angles of neck

Introduction: Talus is a short, compact bone with muscular attachments. Its head and body are oriented in specific manner. Thus it is subjected to modifications due to change of direction of forces by adapting different postures. Here we present an anatomical study on types of calcaneal articular facet and squatting facet with emphasis on anatomical co-relation of squatting facet with different angles at the neck of Talus. Materials and Methods: Total 125 dry tali (right-64 and left-61) were studied with no anomalies or pathology. We observed types of calcaneal articular facet on tali, squatting facet, angle of deviation (AD), angle of inclination (AI) were measured. Statistical evaluation of the measured indices was done. Result and Conclusion: Type II articular facet was the most common type of articular facet on calcaneal surface of tali, 2nd most common being Type I. Squatting facet was observed on 44% of tali on right side while 37.5% tali on left side Average AD and AI were 26 and 125 respectively. We found significantly high AI on right sided tali than left sided. No significant co-relation was observed between the AD and presence or absence of squatting facet but in those tali where squatting facet was present, angle of inclination was significantly larger. We conclude that incidence of calcaneal articular facet and modification on neck of talus (squatting facet with high AI) are attributed to differences in race, habitual activities, posture, gait and level of plane used for locomotion by Indian population. Keywords: Tali, Squatting facet, Neck of tali, Articular facet.

Avascular Necrosis of the Talus.

Talar osteonecrosis results from trauma to the fragile blood supply to the talus. Many etiologies exist that can cause talar osteonecrosis, with the most common being talar neck fractures. Patients with talar osteonecrosis frequently present with progressive ankle pain and limited range of motion. Treatment strategy depends primarily on the stage of disease. Conservative care in the form of medications and bracing treatment can be beneficial for patients with low functional status and early disease stages. Surgical options also exist for early disease without talar collapse that can potentially preserve the tibiotalar joint. Once talar collapse develops, surgical treatment is move invasive and typically involves an arthrodesis or talus arthroplasty. Although some treatment guidelines exist based on the disease stage, talar osteonecrosis is a complex problem, and treatment strategy should always be determined on a case-by-case basis carefully examining all clinical aspects.