Talar Neck Research Articles

English

INTRODUCTION: Talar fractures are difficult and rare injuries with incidence of less than 2%1, are one of the most challenging and devastating injuries with varied prognosis, posing a real time challenge to orthopedic surgeons. METHODS: The study is a prospective multicenter randomized therapeutic study initiated in December '2006 on 40 patients with talus fracture to highlight and compare the different modalities of management of talar fractures in terms of functional and clinical results and complications. RESULTS: Out of 40 patients, 32 were male and 8 were female with a male/female ratio of 4:1. Most fractures were due to RTA in 22 cases. Most fractures were in neck of talus in 20 (50%). Out of 40 talar fractures, 10 were managed conservatively, 18 operated with screw fixation, 4 were fixed with cross K-wires and 8 old cases were managed with Blair's fusion. We experienced complications in 12 cases. DISCUSSION: A high degree of suspicion is required for the diagnosis of talus/ talar processes fractures, talus being the second most common tarsal bone to fracture. The preferred surgical timing for talar neck fractures is controversial. But the scenario in the sub-continent is quite different wherein the patients report late to the hospital often due to ignorance, quack therapy and illiteracy, often presenting with complicated and neglected injuries. Also, published literature and long term prospective studies on talar fractures, its treatment and complications based on our population is lacking.

Modifications on dorsum of neck of talus (Squatting Facets and Trochlear Extensions) in Indians

Objective: Habitual squatting in humans is associated with modifications of ankle especially the neck of the talus (squatting facets) and its trochlear surface (trochlear extensions) that characterize the strong pressure and traction forces on ankle joints in state of hyperdorsiflexion. Present study was done to find out variations and incidences of various types of modifications of neck of talus thoroughly and to determine regional peculiarities of these modifications in Indians. Material and Methods: 300 dry (150 right and 150 left) adult tali were taken for present study. Each talus was examined for the presence of various patterns of articular facets on neck of talus and extensions of its trochlear surface. Statistical analysis of data was performed by using Fisher exact test with 95% confidence limits. Results: Lateral squatting facet was found in 136 tali (45.3%). Incidences of medial, combined & continuous gutter like squatting facets were 7.7%, 3.3% & 4.3% respectively. Lateral and medial extensions of trochlear surface were found in 22.3% and 23.7% respectively. Conclusions: Modifications of the neck of talus (squatting facets and trochlear extensions) are result of prolonged squatting positions which is common habit of Indian population and incidences of these variations can be used as an anthropological marker for racial and regional diff erentiation of unidentified bones.

Talar Neck Fracture after United Tibiotalar Fusion.

Tibiotalar arthrodesis is a well-established treatment for tibiotalar arthritis, for example, in younger high demand patients. Talar neck fractures are less common though well-recognised sequelae of foot ankle trauma. Here we present the clinical case of a 69-year-old male who presented to our institution with a nonunion of a talar neck fracture, having undergone a left tibiotalar fusion 24 years previously. To the authors' knowledge, this injury has only been described once previously in the literature. However, the original case described a fracture sustained in the very early postoperative period following tibiotalar fusion, postulated to be secondary to postimmobilisation osteopaenia or stress risers from metalwork. The aetiology in this case is likely due to axial compression transmitted to the talar neck via the calcaneus. The predisposing factors for nonunion are discussed, highlighting the importance of vigilance for this injury in any patient with concomitant tibiotalar fusion and foot trauma. The management of this patient is discussed.

The Result of Open Reduction and Mini-Plate Fixation for Displaced Talar Neck Fracture

Purpose: We evaluated the complications, radiological and clinical results after operative treatment using a mini-plate for fixation of displaced talar neck fractures. Materials and Methods: There were 20 cases of displaced talar neck fractures from May 2006 to December 2011; we performed a retrospective chart review of 15 patients treated by open reduction and internal fixation using a mini-plate who had more than 2 years of follow-up. According to Hawkin’s classification, there were 7 cases of type II fractures and 8 cases of type III fractures. During postoperative 12-16 weeks we checked magnetic resonance imaging. The assessment of clinical results was based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale. Results: Mean union period was 11.6 weeks (10-15 weeks). Nonunion and malunion did not occur in all cases. The mean AOFAS score was 88.2 points (80-97 points). There were 5 cases of avascular necrosis. Of these, there were 3 cases of body collapse and 4 cases of post-traumatic arthritis. In the statistical analysis, there was no correlation between the elements including gender, Hawkin’s classification and union rates and clinical results. Conclusion: Mini-plate fixation of a displaced talar neck fracture is thought to be a good technique, with a low rate of malunion and also showed satisfactory results in radiological and clinical assessment.

Talar neck fractures: anatomic landmarks of suitable position for posterolateral screw insertion.

The posterolateral window is a suitable position for screw insertion. The aim of this study was to define this position for posterolateral screw insertion. Fifteen adult cadaver ankles were used in this study. When the ankle was positioned in a neutral position, the posterolateral window was exposed. Height and width of the window were measured. Vertical distance from the center of the window to the lateral malleolus tip (LMT), horizontal distance from the center of the window to the lateral of the Achilles tendon (LAT), and horizontal distance from the lateral of the Achilles tendon to the sural nerve (SN) were measured. Additionally, the anatomical relationships between the center of the window (the screw insertion point) and surrounding tissues were noted. The results indicated that the posterolateral window was bounded medially by the lateral tubercle of the posterior process of the talus (LTPT), laterally by the posterior border of lateral malleolar (PBLM), superiorly by the trochlear articular surface (TAS), and inferiorly by the posterior calcaneal facet (PCF). The height and width of the posterolateral window were 1.89±0.04 cm and 0.91±0.01 cm, respectively. LMT was 0.40±0.01 cm, LAT was 0.19±0.02 cm, and SN was 0.62±0.04 cm. The present data showed that posterior screw insertion may be a safer screw insertion technique for talar neck fractures. Performing the operation through the posterolateral window had no negative effect on surrounding tissues such as the flexor hallucis longus and posterior talofibular ligament tissues when the ankle joint was positioned in a neutral position. Additionally, the screw head should be countersunk to reduce intraoperative risk. The posterolateral window is a safer point for posterolateral screw insertion for talar neck fractures.

Three-Dimensional Volume Analysis of Partial Avascular Necrosis after Talar Neck Fracture

Three-Dimensional Volume Analysis of Partial Avascular Necrosis after Talar Neck Fracture

Talar Neck Osteotomy for Subtalar Arthrodesis After Ankle Fusion

Symptomatic subtalar arthrosis after ankle fusion is not uncommon. If conservative treatments such as injections or bracing fail, a successful subtalar arthrodesis can provide predictably good results. However, achieving a successful subtalar fusion with a rigidly fused ankle is a technical challenge. In some cases, the position of the ankle fusion may be suboptimal with the most common malposition being ankle equinus. Subtalar arthrodesis with a talar neck osteotomy allows for reliable bone-on-bone apposition in the subtalar joint. Advantages of this technique include the degree of compression that can be obtained across the subtalar joint, without bone grafting, and the amount of both sagittal and coronal plane malalignment that can be corrected. The purpose of this paper is to describe the operative technique of subtalar compression arthrodesis with talar neck osteotomy. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.

SQUATTING FACETS ON THE TALUS AND TIBIA IN AUSTRALIAN ABORIGINES

presence of the so-called squatting facets on the upper surface of the neck of the talus and on the anterior margin of the distal extremity of the tibia was first described by Thomson (1889). These facets were studied from time to time by a number of investigators in different groups of populations. As Barnett (1954) has pointed out, lack of an agreed terminology has created much confusion in describing these facets. There are five entities to be noted clearly in this context in the case of the talus (Plate I) : Articular Extensions

Antegrade-Retrograde Opposing Lag Screws for Internal Fixation of Simple Displaced Talar Neck Fractures

The talar neck is deviated medially with reference to the long axis of the body of the talus. In addition, it deviates plantarward. The talar neck fracture line is sometimes observed to be oriented obliquely (not perpendicular to the long axis of the talar neck). This occurs when the medially deviated talar neck strikes the horizontally oriented anterior lower tibial edge. Internal fixation of a simple displaced talar neck fracture usually requires 2 lag screws. Because the fracture line is obliquely oriented, a better method for positioning the screws perpendicular to the fracture line is to place them in a reversed direction to provide maximum interfragmentary compression at the fracture site, which could increase the likelihood of absolute stability with subsequent improvement in the incidence of fracture union and a reduction of complications, such as avascular necrosis of the body of the talus. Two lag screws are used, with the first inserted from posteriorly to anteriorly (perpendicular to the fracture line) using a medial approach after medial malleolar chevron osteotomy. The second screw is inserted from anteriorly to posteriorly (perpendicular to the fracture line) using an anterolateral approach. Both screw heads should be countersunk. A series of 8 patients underwent this form of internal fixation for talar neck fracture repair, with satisfactory functional outcomes. In conclusion, the use of antegrade-retrograde opposing lag screws is a reasonable method of internal fixation for simple displaced talar neck fractures.

A Method of Open Reduction of an Irreducible Hawkins Type III Fracture of the Talar Neck

Hawkins type III fracture talar neck may sometimes be a nightmare for surgeons to reduce, even intraoperatively. It is difficult to reduce as the talar body is locked into its dislocated posteromedial position out of both the ankle and subtalar joint. Maneuvers of reduction have been described both in dorsiflexion and plantarflexion of ankle, but these are complicated and not tissue friendly. Further, various methods of grasping and pushing the dislocated talar body by use of joysticks and distractors have been advocated. To accomplish this intraoperatively, we present a convenient and utilitarian method using only 2 smooth 1.5-mm Kirschner wires and a JESS distractor clamp. Two key concepts to keep in mind while reducing such fracture dislocations are also highlighted. This was done in a 22-year-old male with 7-day-old Hawkins type III fracture of the left talar neck and a right Pilon fracture with good results at 2 year follow-up.

Is cement block arthroplasty the next big thing in ankles? Commentary on an article by Ho-Seong Lee, MD, et al.: "cement arthroplasty for ankle joint destruction".

Is ankle replacement so primitive compared with other joint arthroplasties that we look at cement block “arthroplasty” as a success? Of course not, but a casual read of the title of this article might lead an orthopaedist to wonder. Cement block arthroplasty seems like a procedure right out of an orthopaedic text from the 1970s, so why should this be an article in JBJS in 2014? A closer inspection of the study by Lee et al. shows that it is really a collection of three different, rarely indicated procedures: 1. Talar body replacement for patients with a tumor without destruction of the ankle and subtalar joints. Several case reports have shown some success with use of custom talar body implants, with the native talar neck and head left intact or the entire talus replaced with metal or ceramic1,2. 2. Ankle/hindfoot arthrodesis with tibiotalocalcaneal screws and cement for structural support, with the intention of achieving a stable pseudarthrosis. 3. Cement block arthroplasty, in which the cement is a rigid spacer, with emphasis on restoration of alignment. The first procedure, talar body replacement, is a unique operation for a younger …

Talar neck fracture—A rare but important complication following subtalar arthroereisis

Subtalar arthroereisis is a technique for treating symptomatic flexible flatfeet by means of inserting an implant or stent into the sinus tarsi. The goals are to reduce pain, deformity and instability of the foot.However, there are recognised complications associated with this technique which include malposition of the implant, undercorrection/overcorrection of the deformity, persistent sinus tarsi pain, deep medial heel pain, foreign body synovitis, avascular necrosis of the talus, intraosseous cystic formation in the talus, migration of the implant, device extrusion and subtalar joint arthrosis.In this report an unusual complication of fracture of the neck of the talus in a teenager who competes recreationally in ‘at risk’/impact sports, who had previously had arthroereisis screw insertion some years before is presented.

Talar Neck Fractures: An Overview

Talar injuries are infrequently encountered in practice as the majority require a high energy force such as road traffic accident or fall from height and they are often presented as complex injuries. Talar neck fracture accounts for half of these injuries.

The Talar Body Prosthesis: Results at Ten to Thirty-six Years of Follow-up.

Satisfactory results of implantation of the talar body prosthesis were reported in 1997, although some complications associated with the initial design were noted. The present study evaluated outcomes of treatment with a modified talar body prosthesis. Of the thirty-six talar body prostheses implanted with use of a transmalleolar surgical approach from 1974 to 2011, thirty-three were available for follow-up at ten to thirty-six years or had failed prior to that time. The indication for implantation had been osteonecrosis in twenty-three patients, a comminuted talar fracture in eight, and a talar body tumor in two. Twenty-eight of the thirty-three prostheses were still in place at the time of final follow-up and five had failed prior to five years. The duration of follow-up was ten to twenty years in eight patients, twenty to thirty years in eleven, and thirty to thirty-six years in nine. The AOFAS (American Orthopaedic Foot & Ankle Society) ankle-hindfoot score did not differ significantly among these three groups. Patients over sixty-five years of age with underlying disease that impeded walking ability had lower AOFAS scores. Early prosthesis failure occurred as a result of size mismatch in two patients, tumor recurrence in one, infection in one, and osteonecrosis of the talar head and neck in one. These failures, which occurred at eight to fifty-seven months, were treated with tibiotalar arthrodesis in three patients, prosthesis revision in one, and below-the-knee amputation in one. Although early prosthesis failure may occur, survival of the talar body prosthesis can provide satisfactory ankle and foot function. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Epidemiological study on talus fractures

Objectiveto analyze the characteristics of patients with talus fractures and the injuries that they present. Methodsretrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Resultsanalysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusiontalus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.

Estudo epidemiológico das fraturas do tálus

Objectiveto analyze the characteristics of patients with talus fractures and the injuries that they present. Methodsretrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Resultsanalysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusiontalus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high‐energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.

Qualitative and Quantitative Anatomic Investigation of the Lateral Ankle Ligaments for Surgical Reconstruction Procedures.

Lateral ankle sprains are common sports injuries that may require surgery for chronic lateral ankle instability. Anatomic repair or reconstruction is desired, yet there is a scarcity of quantitative information regarding the origins and insertions of the lateral ligaments related to surgically pertinent osseous landmarks. Fourteen ankle specimens were dissected to isolate the anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament, and cervical ligament. A three-dimensional coordinate measurement device was used to determine the origins, insertions, footprint areas, orientations, and distances from osseous landmarks. A single-banded anterior talofibular ligament was identified in seven of the fourteen specimens, and a double-banded anterior talofibular ligament was identified in the remaining seven. The single-banded anterior talofibular ligament originated an average of 13.8 mm (95% confidence interval [CI], 12.3 to 15.3) from the inferior tip of the lateral malleolus at the anterior fibular border and inserted an average of 17.8 mm (95% CI, 16.3 to 19.3) superior to the apex of the lateral talar process along the anterior border of the talar lateral articular facet. The calcaneofibular ligament originated an average of 5.3 mm (95% CI, 4.2 to 6.5) from the inferior tip of the lateral malleolus at the anterior fibular border and inserted an average of 16.3 mm (95% CI, 14.5 to 18.1) from the posterior point of the peroneal tubercle. The posterior talofibular ligament was the largest ligament and originated an average of 4.8 mm (95% CI, 3.7 to 5.9) superior to the inferior tip of the lateral malleolus in the digital fossa to insert an average of 13.2 mm (95% CI, 11.5 to 14.9) from the talar posterolateral tubercle. The cervical ligament originated on the superior part of the calcaneus and inserted at a point that was approximately 50% of the talar neck anteroposterior distance. Consistent distances from the anterior talofibular ligament, calcaneofibular ligament, posterior talofibular ligament, and cervical ligament footprint centers to osseous landmarks were identified. Footprint center distances from surgically relevant osseous landmarks identified in this study can be used during reconstructive surgery of the lateral ankle ligaments and may result in more anatomically accurate placement of the reconstructed ligaments.

Reverse Evans Peroneus Brevis Medial Ankle Stabilization for Balancing Valgus Ankle Contracture during Total Ankle Replacement

Medial ankle instability secondary to deltoid ligament insufficiency is frequently encountered when performing total ankle replacement and remains a challenge. In the present techniques report, we describe a “reverse” Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction for medial ankle stabilization harvested through limited incisions using simple topographic anatomic landmarks. The harvested peroneus brevis tendon is brought through a drill hole in the talus from laterally to medially, aiming for the junction of the talar neck and body plantar to the midline. The tendon is the brought superiorly and obliquely to the anterior medial aspect of the distal tibia where it is secured under a plate and screw construct. This modified Evans peroneus brevis tendon nonanatomic deltoid ligament reconstruction is useful in providing medial ankle stability during or after primary and revision total ankle replacement.

Study on secure tunnel in the fixation of talar neck fracture based on digital technology

Objective To investigate the establishment of secure tunnel in fixation for the talar neck fracture when screws were fixed from the medial wall of talus.Methods The age of volunteers was limited from 20 to 60 years old,and the height of male volunteers was from 165 to 185 centimeters,while the female volunteers' height was from 155 to 175 centimeters.The body mass index (BMI) was less than 25.The volunteers who were not heavy manual workers or standing working for long time had no history of ankle or foot fractures,and there were no evidence of degeneration changes in ankle joints according to X-ray.At last there were 33 males in this study with an average age of 43.7 (21-59) years and an average height of 176.0 (168-184) centimeters.There were 22 females with an average age of 43.2 (22-60) years and an average height of 165.4 (158-172) centimeters.After the volunteers' ankle joints and feet were scanned by CT,the reconstructed images were stored in CD and the slice thickness was 0.75 millimeters.The SuperImageTM Orthopedics Edition1.1 software was used to display the images and perform three dimensional reconstruction.The height of talar neck and the height of tarsal canal were measured.The models that screws passing into tarsal canals were built.The maximal length and angle that screws were inserted in the middle 1/3 and in the inferior 1/3 of medial wall of talus and run along to two directions were measured.At last,the data were analyzed with SPSS 13.0 software.Results The height of talar neck and tarsal canal had no significant difference between left side and right side in the same gender.The height of male talar neck was greater than the female' s.The models of screws passing into tarsal canals was gained.The length and angle in different insert points and different directions of screw fixation were also gained.When the screws were inserted from the middle 1/ 3 of the medial wall of talus,the angle of screw fixation was much wider than that when the screws were inserted from the inferior 1/ 3 of the medial wall of talus.At last,the safe range of the length and angel of screw fixation was calculated.Conclusion Damage of the blood of talus during internal fixation should be avoided.The middle 1/3 of the medial wall of talus is the most favourable choice to the fixation.Combining the digital technology with internal fixation for talar neck fracture could promote the operation' s security and feasibility. Key words: Talus; Fractures, bone; Internal Fixators; Computers, analog

Cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures

Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures.Methods From March 2008 to June 2011,12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery.External fixation in functional position for 12-14 weeks,and the load time was determined by X-ray fracture healing.Functional results were assessed according to AOFAS (American Orthopaedic Foot and Ankle Society) score at last follow-up.Results Twelve cases were followed up for an average of 24 months (12 to 48 months).One case of skin flap necrosis healed by dressing.All the fractures healed,and the mean healing time was 20 weeks (16 to 24 weeks).AOFAS ankle and hindfoot mean postoperative score was 82.5 (ranging from 55 to 96) points.Among them 4 cases were excellent,good in 5 cases,fair in 3 cases.Two cases presented with mild posttraumatic subtalar arthritis and pain relief after oral anti-inflammatory analgesic.One case with avascular necrosis of talus body,and X-ray displayed sclerosis of talus body,but no collapse,and the patient was told to reduce weight and regularly followed up.Conclusion The application of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery for the treatment of talus neck fractures is an effective treatment,which can improves the blood supply of the talus body and reduces the occurrence of avascular necrosis of the talus. Key words: Talus ; Fractures ; Lateral tarsal artery; Cuboid ; Periosteal flap; Transposition