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A case of sarcoma in the talus with the radiographic appearance of a cyst is reported. In spite of local excision of a part of the talus there were local recurrence and metastases. The histologic diagnosis is discussed.
A 23-year-old man injured his foot in a motorcycle accident. Roentgenograms and computed tomography scans demonstrated a Hawkins Type III fracture-dislocation of the talus with a suspected disruption of the anterior tibiofibular ligament. Prompt anatomic reduction of the talus with rigid internal fixation was performed. Intraoperative stress roentgenograms confirmed the presence of a syndesmotic disruption. No cases of this injury have been reported in the literature. When no obvious fracture of the ankle mortise is present in a Hawkins Type III or IV talar fracture-dislocation, care must be taken to fully evaluate the osseous and ligamentous structures of the ankle to rule out an occult injury. Computed tomography scans, stress roentgenograms, intraoperative clinical examination, and direct visual inspection can all be used to aid in this evaluation.
Osteochondral lesions of the talus are common sequelae of ankle inversion injuries. Many often remain undiagnosed, which may lead to chronic pain and disability. Although attributed to other causes, most authors agree that trauma is the most common etiology. Because of this, transchondral or osteochondral fracture is a more appropriate term. Numerous cases have been documented in the literature with a preponderance for the anterolateral and posteromedial portions of the talar dome. Centrally located lesions are rare and should be treated with early surgical intervention due to the high level of compression transmitted through this area. The authors review osteochondral lesions of the talus and present a case report of a rare centrally located lesion.
Authors differentiate four etiological groups of vertical talus. In their material the congenital and symptomatic rocker bottom foot was rarer than the paralytic one. Good result can be expected mainly from the operative treatment. From 69 cases good clinical and radiological result was reached in 58, whereas in 6 cases the treatment had no result. It was their experience that a reduction of the talus and of the navicular bone can be reached by tenotomies and capsulotomies and by these a normal form of the foot can be secured. In the conservation of the operative results the significance of the organized care is stressed.
The ankle joints of 88 professional soccer players have been studied. The high presence of radiographic changes unchained in its great number by impingement phenomena among the articular areas, being 59.1% for the right ankle and 52.3% for the left one, has been confirmed. These radiographic images seem to indicate in the ankle joint the existance of osseous remodeling phenomena to face overuse and overstress, having in the major part of cases no clinical translation, so that we might denominate them as the "radiographic arthrosis of sportsman". Two types of morphological adaptation of the neck of the talus are described to face the impingement unchained in it by the anterior articular border of the distal epiphysis of the tibia. The Type A, in which changes of the "squatting facet" of the talus are detected and Type B characterized by talotibial exostosis.
The results of 25 operated talus fractures are presented. 7 of these were peripheral fractures with excellent results, 18 central fractures with only satisfying or even bad outcome. Although we didn't see any avascular necrosis of the talus, almost all patients had pain and slight or even severe signs of arthrosis in the ankle or subtalar joint.
Varus displacement of the talus in the ankle mortise secondary to a calcaneus fracture was observed in a 33-year-old man. Similar to the calcaneus fracture-dislocation, the mechanism involved inferior and medial displacement of the talus into the body of the calcaneus. The patient's ankle deformity was not corrected by a lateral ankle ligament reconstruction. Correction required a distraction subtalar bone block fusion. Successful reconstruction of the hindfoot after calcaneus fractures requires a careful analysis of the pathologic lesion. In this unusual case, correction required restoration of lost hindfoot bone structure.
The authors present the case of a closed posteriomedial enucleation of the talus, which is the first ever reported in the literature. The patient's course is described and available publications are fully reviewed. The authors believe that in spite of the high rate of necrosis observed in talus enucleations, it is valid to attempt treatment designed to prevent necrosis, reserving arthrodesis for those cases where necrosis has already occurred or where walking is impaired.
There are several types of lesions of the talus, including non united fractures and true osteochondritis in adolescents. This article focuses on lesions of the dome of the talus having a large subchondral necrotic zone. The etiology of these lesions is unclear. Even when they result from trauma, this may not be the sole cause. Thirty-three similar cases were studied, allowing analysis of the radiological appearance and the value of arthro scanner data. All the cases were treated by surgery (and were subsequently classified histologically). The necrosis was treated by curettage and filling with cancellous bone grafts taken from the lower tibial epiphysis. Twenty-seven patients were followed up at least one year (average 3 years 3 months). The outcome was functionally good or very good in twenty-two cases. The anatomical reconstruction was scored by radiology as very good in nineteen patients and satisfactory in five, who had irregularities and non-homogenous appearance of the talar dome. These results justify the use of curettage and filling. Arthroscopic techniques, although appropriate for simple ablations of osteochondral fragments, do not appear to be satisfactory for treating lesions including subchondral necrosis. Filling can only be performed surgically.
We report vertical transmission of isolated congenital vertical talus through three generations of a Honduran family. Five of nine affected family members were examined and the diagnosis was confirmed radiographically. There was incomplete penetrance in one clinically unaffected woman with two affected children. Bilateral and unilateral involvement was seen with a wide range of severity. Based on this family and on cases reviewed from the literature, we propose that isolated congenital vertical talus can be inherited as an autosomal dominant trait with variable expression and incomplete penetrance.
Twenty-four patients who had an osteochondral fracture of the dome of the talus were examined by plain radiography, magnetic resonance imaging, computerized tomography, and, when indicated, scintigraphy. When plain radiographs of the ankle are relied on for the diagnosis of an osteochondral fracture of the talus, many lesions remain undiagnosed. Stage-I osteochondral fractures show no diagnostic changes on plain radiographs, and Stage-II lesions are usually subtle and, therefore, are often overlooked by both radiologists and clinicians. The use of scintigraphy as a screening procedure and of magnetic resonance imaging for patients who have positive scintiscans showed that osteochondral fractures are more common than has previously been indicated in the literature. Scintigraphy should be used to assess patients when there is clinical suspicion of an osteochondral fracture but the plain radiographs appear to be negative. Patients who have positive scintiscans should be assessed by magnetic resonance imaging. Patients who have abnormal plain radiographs will derive no major benefits from magnetic resonance imaging; for all but one of these patients, computerized tomography was adequate for staging the fracture.
The authors have reviewed 23 fractures of the talus in children. They propose a classification based on the radiological maturity of the bone and the specific type of fracture. Group I: Children younger than 6 years (6 cases). The fracture line separates the bone into two parts. The diagnosis was difficult, with displacement being underestimated in some cases. Associated lesions in the same limb were present in 5 cases. Five fractures of the neck of the talus were treated conservatively with excellent or fair results. One comminuted fracture was treated surgically with a poor result. In all cases treatment should aim to maintain a good tibio-tarsal joint. Group II: Children older than 6 years (17 cases). Eight cases were osteochondral fractures, two were partial fractures and seven were complete fractures. Two of these developed subsequent avascular necrosis. The relationship between osteochondral fractures and osteochondritis is discussed.
Fracture of the talus is uncommon, and although it may never be encountered, the knowledge of such occurrences, their treatment, and sequelae should be known by every podiatrist. Aseptic necrosis is a complication that can occur as a result of any trauma to the talus. This might be due to surgical manipulation as in the case of the triple arthrodesis or subtalar arthrodesis, or outside injury due to crushing or rotational injuries.
Osteochondritis dissecans of the talus is a well documented entity, defined as a transchondral fracture of the dome of the talus. As a fracture, it should heal with immobilization; however, this lesion often causes severe disability and, more often than not, the fragment will not unite with conservative treatment. There is much debate concerning operative versus nonoperative treatment, and the purpose of this paper is to discuss the salient points of the controversy, review literature on the subject, and present a case with a follow-up of 4.5 years.
The unique anatomic, functional, and vascular aspects of the talus predispose the area to difficulty in the management of its injuries. This article provides a practical guide to the treatment of fractures and dislocations of the talus.
The talus is a bone with unique biomechanical features and vascular supply. Displaced fractures of the talus, therefore, frequently create problems of proper management. Forty-one severe talar fractures were treated operatively. The incidence of avascular necrosis was relatively low in this series (16%), and all of these were of Type III and IV fractures of the Marti-Weber classification. Type IV fractures were successfully treated by arthrodesis per primam, and suggested that fusion may be the indicated method of treatment in these severe injuries. Fusion of the tibiotalar joint has been used to encourage revascularization and to preserve the important function of the subtalar joint. In all other fracture types with dislocation, anatomic reduction is performed to restore joint congruity and encourage maintenance of talar dome viability. Painstaking postoperative management is important for the complete restoration of function.
Seventy-one fractures through the neck of the talus were clinically evaluated and classified on the basis of roentgenographic appearance. The follow-up interval averaged 12.7 years. Good or excellent results were achieved in 59 per cent of the fractures. Accurate anatomical reduction of displaced fractures, if necessary by open reduction and internal fixation, is recommended. Avascular necrosis of the talar body occurred in 52 per cent of the fractures (in two of thirteen non-displaced fractures, in half of the fractures with subluxation or dislocation of the subtalar joint, and in sixteen of nineteen fractures with complete dislocation of the body of the talus). Many patients with avascular necrosis treated conservatively had satisfactory results. The complications of avascular necrosis, malunion, subtalar arthritis, and infection required twenty-five secondary procedures. Triple arthrodesis, tibiocalcaneal fusion, and dorsal beak resection of the talar neck all resulted in a high percentage of satisfactory results, but talectomy did not.
A 45-year-old woman involved in a motor vehicle accident sustained a fracture of the medial malleolus and a fracture of the neck of the talus. Open reduction and internal fixation of the fractures were achieved through an anteromedial approach. Intraoperatively, the tibialis posterior tendon was found to be ruptured and retracted. The tendon was reapproximated and repaired. The patient developed an inversion deformity of the ankle, which required release of the tibialis posterior tendon and correction of the deformity using the Ilizarov fixation device. Twelve months after the injury, the patient had 45 degrees of plantar flexion and 15 degrees of dorsiflexion of the ankle; subtalar motion was 25 degrees of eversion and 35 degrees of inversion. Radiographs showed healing of all fractures with minimal degenerative changes of the ankle joint and absence of avascular necrosis of the talus.