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At least 217 records · Page 12Linked to original sources
PubMed2003

Osteochondral autografts for osteochondritis dissecans of the talus.

Eighteen symptomatic advanced-stage osteochondritis dissecans (OCD) of the talus (Berndt and Harty stages III 7 and IV 11) in 17 patients were treated with multiple autogenous osteochondral cylindrical grafts. The mean time of follow-up was 36 months (range, 25-49). The average age at surgery was 22.7 years (range, 19-34). The mean size of defect of OCD was 13.6 mm x 7.2 mm. Two or three osteochondral grafts (6 or 7 mm in diameter and 15-20 mm in length) were harvested from the superomedial margin of the ipsilateral knee. A partial osteotomy of the medial malleolus or osteotomy of the distal lateral tibia was performed for all cases. Being evaluated by the Freiburg ankle score, 16 of 18 ankles (88.8%) had excellent and two (11.8%) had good results. "Second-look" arthroscopy of 16 ankles revealed consistency of the osteochondral grafts and congruity between grafts and native cartilage in 14 (87.5%), and a softening or fissuring of the osteochondral graft in two. Our results showed that this procedure provided an effective treatment for a symptomatic advanced-stage OCD of the talus.

Adult↗
PubMed2004

Tibiocalcaneal arthrodesis after total talectomy for treatment of osteomyelits of the talus.

BACKGROUND: Outcomes after talectomy combined with tibiocalcaneal arthrodesis are variable, and there have been few reports of results for tibiocalcaneal arthrodesis after total talectomy using an external fixator as the sole stabilizing modality. METHODS: Three adult patients with chronic talar infections secondary to complex fracture-dislocations of the talus are reported. Each patient was treated with staged radical debridement and total talectomy followed by tibiocalcaneal arthrodesis using interpositional autologous cancellous bone graft and multiplanar external fixation. RESULTS: Solid union was achieved for all patients at an average of 14 weeks (range 10 to 16 weeks). Outcome results, standardized according to the AOFAS Ankle-Hindfoot Scale and the Modified Mazur Ankle Arthrodesis questionnaire, were good for all patients at a mean followup of 31 months (range 20 to 48 months). One patient had a leg-length discrepancy of 1.5 cm. CONCLUSION: The presented technique for tibiocalcaneal arthrodesis is an option for salvage of infection or complex injuries of the talus.

Adolescent↗
PubMed2006

Characterization of lesions of the talus and description of tram-track lesions.

BACKGROUND: The ankle joint, although not prone to primary osteoarthritis (OA), is known to be susceptible to secondary OA as a result of sports injuries and other trauma. Unlike the knee joint, a thorough investigation of talar cartilage lesions has not been previously reported. METHODS: One hundred and five human tali from 67 donors were used to determine the type and location of the most common lesions through gross examination, radiography, diffraction enhanced imaging, and histology. "tram-track lesions" also are described. RESULTS: The most anterior and posterior regions of the talar dome, along with the medial and lateral borders of the dome were most affected by cartilage degeneration. These are regions that appear to be most subjected to frictional forces from their articulating counterparts during high stress activities that move articulating surfaces slightly out of congruence with each other. One particularly striking cartilage degeneration pattern that, to our knowledge, has not been described histologically, is the tram-track lesion. These lesions displayed a longitudinally oriented groove in the cartilage, running from anterior to posterior, in which the deepest portion of the groove was located in the middle of the anterior-posterior axis of the talus. Several of these cartilage grooves had a bony ridge beneath, mirroring the cartilage groove whereas others did not. This suggests that the cartilage groove develops before the interruption of the tidemark (border between the calcified and uncalcified cartilage). In specimens for which the articulating tibial articular surface was available, (17) it was found that the tibia displayed small osteophytes on the anterior articular margin that exactly corresponded to their articulation with the talar cartilage grooves as the ankle articulated through plantar flexion and dorsiflexion. CONCLUSION: This study provides an in-depth histologic and gross anatomic look at the most common lesions of the talus of the ankle joint. In particular, the "tram-track" lesion was shown to be a consequence of its tibial articulation and to include both subchondral bone and articular cartilage changes.

Adult↗
PubMed2006

Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus.

BACKGROUND: Operative treatment of large osteochondral lesions of the talus is difficult because the blood supply is poor in the talar dome. The purpose of this study was to evaluate the results of a vascularized bone graft transfer from the medial calcaneus to the large osteochondral lesion. METHODS: Four ankles in four patients with medial osteochondral lesions were treated through a medial transmalleolar approach. Vascularized bone graft was harvested from the medial calcaneus using the calcaneal branch of the posterior tibial artery and was placed through a fenestration of the medial aspect of the talar dome. The mean duration of postoperative followup was 34 (range 24 to 48) months. Clinical and radiographic evaluations were made before surgery and at final followup. RESULTS: According to the AOFAS ankle-hindfoot scale, mean pain and function scores improved from 20 to 33 points and 30 to 43 points, respectively. The mean total score improved from 60 to 83 points. Plain radiography at followup showed slight osteosclerosis in all patients, but joint space narrowing was not seen in any patient. Cysts seen preoperatively on MRI or CT resolved after 12 months postoperatively, and MRI or CT did not reveal any findings indicative of osteonecrosis. CONCLUSIONS: Clinical and radiographic results were satisfactory. Vascularized bone grafts harvested from the calcaneus were successful for the treatment of large osteochondral lesions of the medial talus.

Adult↗
PubMed1980

Congenital convex pes valgus: results of an early comprehensive release and a review of congenital vertical talus at Richmond Crippled Children's Hospital and the University of Alabama in Birmingham.

Nineteen patients with 28 feet with congenital vertical talus were reviewed. The male to female ratio was equal, and associated congenital abnormalities were found in 15 of the 19 patients. No genetic pattern was established. Fifteen of the 16 surgically corrected feet were reevaluated, with an average follow-up of 60 months. Ten of the 15 feet were found to be in the good to excellent category, and five were rated poor. Twelve of 12 feet treated by cast correction were poor. Poor prognostic signs include late age of surgical correction, associated arthrogryposis and cerebral palsy, and an increased space between the calcaneus and cuboid. Best results occurred in those patients who had early surgical correction, after 4 to 6 months of serial casting, using magnification. Surgical technique which yielded the best results involved total release of the talus from the posterior, medial, and lateral approach, with reduction of the talocalcaneal as well as the talonavicular joints with multiple pin fixation. Lengthening of the Achilles tendon, extensor tendons, and peroneal tendons and transfer of the anterior tibialis to the navicular are recommended. Navicular excision was not found to be necessary. Surgical results in those patients over 3 1/2 years of age were found to be poor, and these individuals were considered for salvage procedures using a subtalar extra articular arthrodesis, excision of the navicular, or triple arthrodesis, depending on age.

Casts, Surgical↗
PubMedDate not supplied

The arterial anatomy of the talus.

The extraosseous and intraosseous vascularity of the talus was studied in 26 fresh cadaver limbs. The specimens were injected with latex or Batson's compound, debrided by a nondissection technique, and cleared by a modified Spalteholz method. The extraosseous vascularity was through the branches of the three major regional arteries which entered the five nonarticulating surfaces of the bone. The major blood supply to the body was provided by the artery of the tarsal canal. The deltoid and sinus tarsi vessels provided significant minor sources of vascularity. The superior neck and posterior tubercle vessels supplied small areas of the body, but did have anastomoses with the other arteries in some specimens. These vascular patterns correlated well with the reported incidence of avascular necrosis of the body of the talus following injury.

Arteries↗
PubMedDate not supplied

Congenital vertical talus: the Riley experience.

This is a retrospective study of seven patients with 10 feet displaying nonparalytic congenital vertical talus treated at Riley Children's Hospital in Indianapolis by open reduction without naviculectomy. Each of the 10 feet underwent an operation for open reduction of congenital vertical talus. The procedure included a peritalar soft tissue release, posterior release of the hindfoot with Achilles tendon lengthening, and transfer of the tibialis anterior tendon into the talar neck. Length of follow-up ranged between 2 and 11 years. Average follow-up time was 6 years and 9 months. Age at time of open reduction ranged from 8 months to 3 years. The clinical follow-up evaluation revealed three excellent, three good, and four fair results. Only one patient underwent a subsequent surgical procedure.

Achilles Tendon↗
PubMedDate not supplied

Congenital vertical talus.

This series consisted of 15 congenital vertical tali in 12 patients, 11 of which were treated surgically and the remainder conservatively. Conservative treatment (casting alone) yielded poor results in three of four feet, while the results in the surgical group were four good, six fair, and one poor at an average follow-up of 8 years. The surgical procedures included a one-stage release with transfer of the anterior tibial tendon to support the neck of the talus. A Grice arthrodesis was performed either concurrently or within 2 to 4 years. The best results were obtained with early subtalar arthrodesis (Grice) and biplanar K wire fixation. Complications included skin sloughs, avascular necrosis of the talus, and pin tract drainage. Attempts to augment push-off power with tendon transfers were unrewarding.

Ankle Joint↗
PubMed1986

Osteochondritis dissecans of the talus.

Osteochondritis dissecans of the body of the talus is a common entity; however, osteochondritis dissecans of the head of the talus has not been found in the orthopaedic literature. The authors report a case of a defect in the talar head following trauma to the ankle, which has radiographic characteristics of osteochondritis dissecans.

Adolescent↗
PubMed1988

Complicated fractures of the neck of the talus.

Seven patients with a complicated fracture of the neck of the talus were followed up by a clinical and radiographic investigation. One had an excellent result and four had good results. Four developed avascular necrosis of the body of the talus and the treatment of this serious complication is discussed.

Accidents, Traffic↗
PubMed1989

Posterior instability of the talus: an anatomic evaluation.

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.

Ankle Joint↗
PubMed1992

Excision of ununited fractures of the posterior process of the talus: a treatment for chronic posterior ankle pain.

The cases of nine patients with ununited fracture of the posterior process of the talus were reviewed. The most common mechanism of injury was forced plantarflexion. All patients had pain in the posterior ankle region. Common physical findings included tenderness between the lateral malleolus and the Achilles tendon and pain on forced plantarflexion. Of the radiographic imaging modalities used, 99Tc bone scan was found to be the most helpful in diagnosis. All nine patients eventually underwent surgical excision at a mean period of 9.4 months post injury. At average follow-up of 27 months after surgery (range 7-69 months), six of nine patients had good or excellent results with respect to pain relief and return to function. There were two complications of sural neuroma formation, one of which resulted in severe persistent pain after surgery. Based on these findings, we believe the differential diagnosis of chronic posttraumatic ankle pain should include fracture of the posterior process of the talus. Furthermore, excision of an ununited fragment through a lateral approach, taking care to preserve and protect the sural nerve, should lead to the return of painless function in the majority of cases.

Adult↗
PubMed1993

Comminuted fracture of the calcaneus associated with subluxation of the talus.

Two cases of complex fracture dislocation of the calcaneus having an unusual pattern of injury are described. The cases exhibit the following special characteristics: (1) fracture dislocation of the calcaneus where the primary fracture line separates the calcaneus into an anteromedial fragment that maintains its normal relationship to the talus and a posterolateral fragment that is dislocated from the subtalar joint. This posterolateral fragment moves laterally and lies adjacent to the fibula; (2) a secondary fracture line separating the lateral portion of the posterior facet from the tuberosity of the calcaneus. Both fragments are dislocated from their normal anatomical position; (3) talar tilt as shown on AP view of the ankle caused by inversion of the talus due to rupture of the lateral collateral ligament. Also, the posterolateral fragments impinging on the fibula pushes the heel downward and contributes to the talar tilt; (4) involvement of the calcaneocuboid joint; (5) dislocation of the peroneal tendons. This fracture pattern is unusual and has not been described before. Recognition of this unusual injury with subsequent and proper management may prevent major disability to the patient. Conservative treatment by casting or early range of motion is contraindicated. Closed reduction should be attempted immediately, and if not successful, a lateral approach with open reduction and internal fixation is the treatment of choice for this complex injury.

Adult↗
PubMedDate not supplied

Intraosseous ganglion cyst of the talus: case report.

A case of an intraosseous ganglion cyst of the talus is described. Ganglion cysts within bone are not rare but are usually found within long bones located in metaphyseal areas. This lesion of the talus produced significant pain and was successfully treated with curettage and iliac crest bone graft.

Adult↗
PubMed1996

Fracture of the medial tubercle of the posterior process of the talus: a case report and literature review.

A 32-year-old man experienced pain behind the medial malleolus and an inability to bear full weight after jumping approximately 3 feet during a basketball game. A diagnosis of fracture of the medial tubercle of the posterior process of the talus was made, and the patient was treated for 7 weeks in a nonweightbearing cast. Twenty-four-month follow-up demonstrated no limitation of activity. To our knowledge, this is the first reported case of fracture of the posterior process of the talus that was treated nonoperatively with a successful outcome.

Adult↗
PubMed1996

Ipsilateral fractures of the talus and calcaneus.

Nine ipsilateral fractures of the talus and calcaneus were treated at Tampa General Hospital between 1991 and 1994 and entered into the trauma registry of this level 1 trauma center. During this same period, a total of 78 talar fractures and 334 calcaneal fractures were entered into the registry. The patients who sustained this rare combined injury were studied retrospectively to characterize the fractures that occurred, examine the treatments instituted, and determine outcomes. Four patients had severe intra-articular damage of the subtalar joint surfaces and underwent either primary or delayed arthrodesis. This subgroup of patients was followed for an average of 39 months (range, 25-45 months), and all had excellent or good outcome as assessed by the Maryland Foot Score. Three patients had nondisplaced or avulsion-type fractures of both bones, which were treated with immobilization. These all healed well. One patient had a Hawkins type 2 talus fracture with an extra-articular avulsion fracture of the Achilles tendon. This patient did well with open reduction and internal fixation of both fractures. The final patient had a crushed lower extremity in association with her hindfoot injury, which resulted in primary below-knee amputation. In general, we believe each individual fracture in this combined injury can be addressed with standard treatment regimens.

Adult↗
PubMed1998

Case report: fracture of the posterior medial tubercle of the talus secondary to direct trauma.

Isolated fracture of the posterior medial tubercle of the talus is a rare injury, generally thought to result from a pronation-dorsiflexion force causing avulsion of the insertion of the posterior talotibial ligament. Originally described by Cedell, the fracture has subsequently been reported three times to our knowledge, with all cases being attributed to indirect trauma. We describe an isolated fracture of the posterior medial tubercle of the talus caused by direct trauma. The fracture of the posterior medial tubercle remained ununited, failed to respond to conservative therapy, and was treated successfully with surgical excision.

Adult↗
PubMed1999

Open reduction and internal fixation of fracture of the posterior process of the talus: a case report and review of the literature.

A fracture of the posterior process of the talus is rare. In this report, we present a case of isolated displaced fracture of the posterior process of the talus, which was treated by early open reduction and internal fixation through a posteromedial approach. The fracture healed without evidence of avascular necrosis of either the posterior fragment or the talar body. The purpose of this article is to highlight the importance of early postoperative management of this uncommon type of fracture.

Adult↗