Tarsal Fractures Research Articles

Fractographic examination of racing greyhound central (navicular) tarsal bone failure surfaces using scanning electron microscopy.

The greyhound is a fatigue fracture model of a short distance running athlete. Greyhounds have a high incidence of central (navicular) tarsal bone (CTB) fractures, which are not associated with overt trauma. We wished to determine whether these fractures occur because of accumulation of fatigue microdamage. We hypothesized that bone from racing dogs would show site-specific microdamage accumulation, causing predisposition to structural failure. We performed a fractographic examination of failure surfaces from fractured bones using scanning electron microscopy and assessed microcracking observed at the failure surface using a visual analog scale. Branching arrays of microcracks were seen in failure surfaces of CTB and adjacent tarsal bones, suggestive of compressive fatigue failure. Branching arrays of microcracks were particularly prevalent in remodeled trabecular bone that had become compact. CTB fractures showed increased microdamage when compared with other in vivo fractures (adjacent tarsal bone and long bone fractures), and ex vivo tarsal fractures induced by monotonic loading (P < 0.02). It was concluded that greyhound racing and training often results in CTB structural failure, because of accumulation and coalescence of branching arrays of fatigue microcracks, the formation of which appears to be predisposed to adapted bone.

Long-term outcome of horses with a slab fracture of the central or third tarsal bone treated conservatively: 25 cases (1976-1993).

To determine clinical features of horses with a slab fracture of the central or third tarsal bone and to report outcome of horses in which treatment did not include surgery. Retrospective study. 25 horses (14 Standardbreds, 6 Thoroughbreds, 5 Quarter Horses). Medical records of horses with a slab fracture of the central (n = 9) or third (16) tarsal bone were reviewed. Only horses for which treatment consisted of confinement to a stall were included in this study. Clinical features and radiographic findings were recorded and summarized. Outcome was determined for racing breeds by obtaining official lifetime race results. Outcome for Quarter Horses was determined by phone survey of the owners. 16 (64%) horses had a successful outcome. Ten of 14 (71%) Standardbreds and 2 of 6 Thoroughbreds returned to racing and started at least 5 races after injury. Four of 5 Quarter Horses for which follow-up information was available successfully returned to their previous activity. Sex, age, limb affected, or gait was not associated with final outcome. Percentage of racehorses with central tarsal bone fractures that had a successful outcome (2/7) was significantly less than percentage with third tarsal bone fractures that did (10/13). Results suggest that enforced rest without surgical fixation can be an effective therapeutic option for horses with a slab fracture of the central or third tarsal bone, even if athletic function is expected.

Fracture–dislocation of the first metatarso–phalangeal joint

Dislocation of the first metatarsophalangeal (MTP) joint is rare [1]. Dislocation is usually dorsal, with isolated case reports of medial dislocation [2,3]. The most common cause of dorsal dislocation is high-energy force acting from distal to proximal [4]. Concomitant foot injuries sometimes seen are lesser metatarsal neck fracture/MTP joint dislocation, tarsal fracture or Lisfranc-type injuries [4,5]. We present a case of first MTP joint fracture–dislocation, which required open reduction and percutaneous fixation. There have been no descriptions of this injury in the literature.

Outcome and Racing Performance after Internal Fixation of Third and Central Tarsal Bone Slab Fractures in Horses

Twenty horses with central and third tarsal bone slab fractures, were treated internal fixation. Eighteen of the 20 cases were Standardbred trotters, one was a Thoroughbred racehorse and one a Swedish Warmblood. The central tarsal bone (CT) was involved in 12 cases and the third tarsal bone (T3) in 8 cases. The fractures were treated by lag screw fixation with one (18 cases) or two (2 cases) 3.5 or 4.5 mm cortical screws. Horses were confined to stall rest for one month and then put on a gradually increasing exercise programme. Convalescence time was 3-8 months until the fracture had healed and training could be resumed. Fifteen of the horses regained athletic soundness. Thirteen of the horses (72%) raced after surgery (12 Standardbreds and 1 Thoroughbred). Nine (69%) of these 13 horses won races after surgery.

Comparison of the conservative and operative treatment of the intraarticular calcaneal fractures

The calcaneal fracture, which is considered to be the most common tarsal bone fracture, has rather difficulty in accurate diagnosis, classification and proper treatment. Furthermore, its prognosis is not good, either. The authors analysed 68 intraarticular calcaneal fractures (Sanders type II & III only) out of 147 cases, which were treated operatively or conservatively from June 1990 to May 1997, and found out that the results of conservative and operative treatment were approximately the same. The length of follow-up ranged from one year to four and half years (mean, 2.7years). The results were as follows: Of the 24 conservatively treated group, seven had excellent; eleven good; four fair; and two poor result. Of the 44 operatively treated group, eleven had excellent; twenty seven good; five fair; and one poor result. The sum of excellent and good results in conservative and operative treatment group were 75.0% and 86.4% each other, and these were not meaningful statistically (p=0.400). Therefore, the authors recommend a conservative treatment as an effective alternative method for the intraarticular calcaneal fracture.

MR imaging of the tarsometatarsal joint: analysis of injuries in 11 patients.

We evaluated how well MR imaging revealed ligamentous and bony abnormalities in patients with injuries of Lisfranc's joint. We evaluated the studies of 11 patients with plantar hyperflexion injuries of the foot who underwent MR imaging in all three planes using spinecho T1-weighted, fast spin-echo T2-weighted, and short inversion time inversion recovery sequences. In four of the 11 patients, a three-dimensional spoiled gradient-recalled acquisition in the steady-state volume sequence was performed in the coronal plane. For five of the 11 patients, radiographs were available for evaluation. Radiographs revealed tarsometatarsal joint malalignment in all five patients for whom plain films were available, metatarsal fractures in four of these patients, and tarsal fractures in the same four patients. MR imaging showed joint malalignment in all 11 patients and disruption of the Lisfranc's ligament in eight of the 11 patients. In the remaining three patients, normal Lisfranc's ligaments were associated with avulsion fractures of the second metatarsal bases or the medial cuneiform bones. On MR imaging, fractures of the metatarsal bases were evident in 10 of 11 patients. Fractures of the tarsal bones were seen in the same 10 patients. MR imaging allows the detection of disruption of the Lisfranc's ligament as well as tarsal and metatarsal fractures and therefore may be a valuable technique in assessing patients after trauma to the tarsometatarsal joints when results of routine radiographs are not conclusive.

A study of metatarsal fractures in children

The purpose of our study was to document the sites and distribution of mid-foot and fore-foot fractures in children, relating them to the pattern of injury with particular reference to the first metatarsal. The clinical records and radiographs of 388 children with foot injuries were examined. A total of 62 metatarsal and seven tarsal fractures were identified in 60 children. The commonest fracture was of the fifth metatarsal, 45 per cent overall; 90 per cent of these children were over 10 years old. In children under 5 years old, first metatarsal fractures accounted for 73 per cent, but in children over 5 years old, these fractures accounted for only 12 per cent of the total. In all, 6.5 per cent of all fractures and 20 per cent of first metatarsal fractures went unrecognized at the initial attendance.

Central Tarsal Bone Fracture in Two Dalmatians

SummaryTwo adult female Dalmatians had type III fractures of the left central tarsal bone. In one the fracture occurred during strenuous exercise, while the cause was not identified in the other dog. Open reduction and internal fixation of a large medial bone fragment was achieved with a medial-lateral directed lag screw into the fourth tarsal bone. A 2.7 mm cortical screw was used in one animal and a 4.0 mm partially threaded cancellous screw in the other. At follow-up examination both dogs were free from lameness.Central tarsal bone fractures were repaired using lag screw fixation in two Dalmatians. Other than in racing greyhounds, this fracture is rare in dogs.

Tarsal injuries in the cat: A retrospective study of 21 cases

ABSTRACTA retrospective study of 21 surgically treated feline tarsal injuries showed that the degree of soft tissue trauma was the main parameter influencing the long term outcome. Generally, tarsal fractures could be successfully reconstructed and managed by internal fixation. Simple rupture of a collateral ligament could be sutured or treated with a suture prosthesis, resulting in a good long term result. Intertarsal instabilities were successfully treated by the application of miniplates resulting in stable ankyloses. Talocrural luxations evaluated in this study had a poor long term outcome. Further research is needed to show if alternative postoperative management involving early mobilisation and physiotherapy might improve the outcome of talocrural luxations with severely damaged soft tissues.

Intraarticular Fractures of the Foot

In the absence of historical comparative data for the treatment of tarsal fractures, commonly abided maxims of trauma care are noteworthy. A displaced fracture involving an articular surface or a fracture interrupting a mechanical axis is treated by open reduction and internal fixation. Rigid fixation is followed as early as possible with active and passive mobilization. Unlike long bones, whose motion and fracture patterns (i.e., segmental, transverse, and oblique) are understood, the tarsal bones are small bones with complex shapes and restricted motion. As a result, tarsal injuries most often occur with multiple ligamentous and bony injuries. Articular step-off is difficult to establish roentgenographically, the blood supply is tenuous, and fixation is largely dependent on screws and Kirschner wires. Good outcome can be obtained by following principles of internal fixation established in treatment of major joint injuries.

Conservative management of fourth tarsal bone fracture in a draft horse

Conservative management of fourth tarsal bone fracture in a draft horse

Depressed fracture of the cuboid. A case report and a method of treatment

The cuboid is an important bone of the foot. Isolated fractures of the cuboid are unusual. Often when the cuboid is injured there are other associated tarsal injuries, either fractures or dislocations. We present a case of an isolated depressed cuboid fracture caused by relatively minor trauma in a healthy woman, and describe a novel method of treatment. We emphasize that a high degree of awareness must be employed if these fractures are not to be missed.

Lag screw fixation of a sagittal fracture of the talus in the horse

This is a report of the surgical technique used to repair a non-displaced, complete sagittal fracture of the talus in a horse utilizing lag screw compression. A review of tarsal fractures in horses along with the history, clinical signs, and diagnostic workup which led to the diagnosis of a previously unreported type of tarsal fracture is presented. The horse presented in this report, returned to race successfully but at a lower level of competition.

Delayed unions and nonunions of stress fractures in athletes.

From 1971 to 1985, 369 athletes presented to us with stress fractures. Of these patients, 10% (37) were treated for development of delayed unions or nonunions. Twenty-seven of the patients were male and 10 were female. Their mean age was 23.1 years (range, 17 to 39). About half of the athletes were involved in endurance sports. The diagnostic criteria for a delayed union or nonunion were clinical and radiological evidence. There was a diagnostic delay of about 3.5 months in the series. Plain radiographs, tomography, and isotope scans were used in the diagnosis. Special radiographic views were also used. In 15 cases (10 hallux sesamoid bone fractures, 1 midtibial shaft fracture, 1 metatarsal V base fracture, 1 tarsal navicular fracture, 1 olecranon fracture, and 1 proximal tibial shaft fracture) nonoperative treatment was used. Operative treatment was used 22 times (5 sesamoid fractures, 5 midtibial fractures, 5 metatarsal V base fractures, 3 tarsal navicular fractures, 3 olecranon fractures, and 1 proximal tibial shaft fracture). Results were good or excellent in 32 cases (86.5%), moderate in 4 cases, and poor in 1 case.

Stress fractures in athletes. A study of 320 cases.

We analyzed cases of 320 athletes with bone scan-positive stress fractures (M = 145, F = 175) seen over 3.5 years and assessed the results of conservative management. The most common bone injured was the tibia (49.1%), followed by the tarsals (25.3%), metatarsals (8.8%), femur (7.2%), fibula (6.6%), pelvis (1.6%), sesamoids (0.9%), and spine (0.6%). Stress fractures were bilateral in 16.6% of cases. A significant age difference among the sites was found, with femoral and tarsal stress fractures occurring in the oldest, and fibular and tibial stress fractures in the youngest. Running was the most common sport at the time of injury but there was no significant difference in weekly running mileage and affected sites. A history of trauma was significantly more common in the tarsal bones. The average time to diagnosis was 13.4 weeks (range, 1 to 78) and the average time to recovery was 12.8 weeks (range, 2 to 96). Tarsal stress fractures took the longest time to diagnose and recover. Varus alignment was found frequently, but there was no significant difference among the fracture sites, and varus alignment did not affect time to diagnosis or recovery. Radiographs were taken in 43.4% of cases at the time of presentation but were abnormal in only 9.8%. A group of bone scan-positive stress fractures of the tibia, fibula, and metatarsals (N = 206) was compared to a group of clinically diagnosed stress fractures of the same bone groups (N = 180), and no significant differences were found. Patterns of stress fractures in athletes are different from those found in military recruits. Using bone scan for diagnosis indicates that tarsal stress fractures are much more common than previously realized. Time to diagnosis and recovery is site-dependent. Technetium99 bone scan is the single most useful diagnostic aid. Conservative treatment of stress fractures in athletes is satisfactory in the majority of cases.

Fractures of the calcaneus in racing greyhounds.

Fifty-one calcaneus fractures associated with (41) or without (10) central tarsal bone (Tc) fractures in racing greyhounds were evaluated and categorized. All calcaneal fractures with no Tc fractures had a plantar proximal intertarsal subluxation. No subluxations were found in dogs with both calcaneal and central tarsal fractures. The calcaneal fractures were treated either with coaptation splints or surgical repair. Surgical techniques included a Steinmann pin with a figure eight tension band device or screw or plate fixation as primary techniques supplemented by Kirschner wires and cerclage wires. In all calcaneal fractures associated with plantar proximal intertarsal subluxation, an arthrodesis of the calcaneoquartal joint was performed. All 22 surgically repaired fractures in dogs available for physical and radiographic reexamination had healed within 1 to 6 months. Eight dogs with fractures of the calcaneus associated with fractures of Tc returned to a racing career. None of the dogs with plantar proximal intertarsal subluxation raced again. Based on the orientation of the fracture lines and on dissection of two tarsi with calcaneal fractures, a hypothesis on the pathogenesis of calcaneal fractures in racing greyhounds was formulated.

The onset and consequences of tarsal bone fractures in foals

Fractures of the central tarsal and/or third tarsal bones involving both limbs of six foals are described. Five of the subjects were born either premature or of twin pregnancies. Fractures occurred in the neonatal period and coincided with disablement. Features of behaviour, posture and gait are described, together with gross radiographic findings, bone ash determination and blood chemistry. Lesions observed on the articular faces of tarsal bones recovered from adult horses may have originated during the neonatal-period.

Pelvic fractures of seat belted car occupants

From November 1974 to June 1978 60 severely injured car-occupants wearing seatbelt were treated at the department of surgery, University of Kiel. Ten of them sustained pelvic fractures. The cause of the injury was a direct pelvic trauma from the crashed car in 6 passengers. The maximum load on the pelvis was exceeded by the seatbelt during the delay of the car only in 4 patients. Contrary to the trauma by the lap-belt with abdominal-, lumbar spine, and pelvic injuries (seatbelt-syndrome by Garrett and Braunstein [5]) we found car-occupants with a threepoint-seatbelt injuries of the thorax, of the head with facial fractures and rarely with cerebral trauma, and of the legs with tarsal fractures. In our cases and in the literature pelvic fractures of car-passengers, who are wearing threepoint-seatbelts, are rare.

Multiple Tarsal Bone Fractures in a Bennet's Wallaby

Multiple Tarsal Bone Fractures in a Bennet's Wallaby

SURGICAL TREATMENT OF TEMPORAL ENTROPION OF THE UPPER EYELID.

Entropion of the upper lid has been treated by multiple surgical procedures. Among the best are variations of tarsal fracture and the free wedge tarsal transplant. Because of the importance of secondary corneal scarring, most of the literature on entropion of the upper eyelid refers to the central third of the lid. Entropion of the temporal third of the upper eyelid can occur without central lid involvement. In temporal entropion the tarsus is unusually soft, bending beneath the lax overhanging skin. The lashes are turned down against the conjunctiva, often trapped beneath the margin of the lower lid. The following modification of the wedge tarsal transplant has been successful in the correction of temporal entropion.