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Total dislocation of the talus without a concomitant fracture is an extremely rare injury. Such a case was treated by immediate closed reduction and 6 weeks of cast immobilization. At the 9-year follow-up, the patient had a full range of ankle motion without any signs of avascular necrosis or arthritis.
We present histopathologic and imaging features, treatment alternatives, and follow-up of a patient with a secondary chondrosarcoma of talus. A 27-year-old man with a chondrosarcoma arising from a preexisting benign tumor was treated by talectomy. At 3 years' follow-up, there is no evidence of recurrence or metastasis. The patient can walk with slight limp without the aid of external support.
A 29 year old vietnamesian patient comes to an examination because of pain in the ankle one week after the arrival in Germany. The clinical examination is inconspicuous, x-ray pictures show a necrosis of the talus. A puncture is sterile. A partial astragalektomie is done. Histology demonstrates a tuberculosis.
The histories of 56 patients with the diagnosis "osteochondrosis dissecans tali" were retrospectively analyzed with regard to etiology, localization, therapy, course, and prognosis. Some of the patients were reexamined. In 33 patients it is highly probable that the osteochondrosis dissecans was not associated with the sequelae of osteochondral fractures. The typical X-ray image is that of a medial, deep osteolysis on the trochlea of the talus, close to the margin, with one or more roundish dissections. There are usually no degenerative or posttraumatic changes. The history and frequent bilateralism tend to rule out trauma as the cause. In the authors' opinion, therefore, the term "osteochondrosis dissecans" should not be used for osteochondral fractures and their sequelae. A number of borderline cases are critically discussed.
Tumors and tumor-like conditions in the talus are rare.--In our first case operation revealed a benign osteoblastoma, in the second case an solitary bone cyst. Microscopic findings allowed other diagnoses too, but our diagnoses were made on the basis of clinical appearance and X-ray and histological findings. After local resection and insertion of bone chips in the one case and curettage and filling with bone chips in the other, healing was complete.
A patient with a benign condroblastoma of the talus bone is described. A review of the pathogenesis and more common sites of predilection of this unusual tumor is presented. This is the first case, to our knowlege, shown by labeled phosphate scanning.
Bone scintigraphy is a very useful technique for detection of aseptic necrosis. We have used this diagnostic tool in a patient to detect aseptic necrosis of the talus, a common complication stemming from foot injuries. The scintigraphic pattern is rather typical and antedates any other radiographic changes. This technique appears to be very useful for diagnosis and follow-up of aseptic necrosis occurring during talar injuries.
Persistent pain in the ankle after relatively minor trauma is common and usually resolves spontaneously. Two cases of persistent pain after minor trauma are presented that involved unusual characteristics of scintigraphic and magnetic resonance imaging, compatible with avascular necrosis of the talar body. This is a rare finding in the absence of steroid use or significant trauma to the foot. The unusual vascular anatomy of the talus is considered in the possible mechanism of injury.
Eight patients with osteochondritis dissecans of the talus were reviewed. The average followup was 17.6 months (range, 8-26 months). The mean age of the patients was 31.8 years (range, 22-42 years). All patients had a preoperative examination, magnetic resonance imaging, and radiologic classification of the lesion through regular anteroposterior and lateral radiographs. Diagnostic arthroscopy and biopsies of healthy cartilage were done, which then had chondrocyte extraction and culture. After an average of 2.5 weeks, an arthrotomy, malleolar osteotomy, subchondral bone sclerosis debridement, and autologous chondrocyte transplantation were done. The postoperative treatment included nonweightbearing for 6 to 7 weeks, physiotherapy, and continuous passive motion. According to the postoperative evaluation score, all results were excellent to good with an average score of 0.6. No complications occurred. The arthroscopic reexamination of three patients at the sixth postoperative month and the radiologic evaluation of all patients showed the existence of cartilagelike tissue with complete coverage of the chondral defect. This method enables reconstructive intervention for unicompartmental defects of articular cartilage through implantation of new chondrocytes, establishment of a subchondral blood supply, and reconstruction of the articular surface.
Magnetic resonance (MR) imaging of the painful ankle of a 15-year-old boy revealed the nidus of a subarticular osteoid osteoma of the talus along with markedly abnormal signal intensity in the neighboring bone marrow. This MR appearance correlated with alterations in the neighboring bone marrow documented by histopathologic examination.
The primary objective of this study was to determine if magnetic resonance (MR) could accurately predict the arthroscopic stage of osteochondritis dissecans lesions of the knee and ankle. Twelve patients, who were indicated for arthroscopy on either clinical or radiographic findings, underwent an MR examination prior to arthroscopy. All scans were performed on a 0.35 T magnet using the same spin echo sequence: repetition time 1,000 ms and echo time 40 ms. Magnetic resonance scans were interpreted prospectively (D.W.N.) and retrospectively (J.S.) by the radiologists without knowledge of the arthroscopic findings. Both radiologists predicted the exact grade in 11 of 12 patients. A single Grade 2 lesion was called Grade 3 by both radiologists. An MR staging classification has been developed that allows accurate preoperative staging of osteochondritis dissecans lesions of the talus and knee.
Between 1983 and 1989, 11 open grade IIIB ankle or talus fractures were treated according to protocol including debridement, temporary placement of antibiotic beads, soft tissue coverage (including seven free vascular tissue transfers), intravenous antibiotics and fusion using an anterior plate, and bone graft. All patients had a minimum of three separate hospitalizations. Each had at least five operative procedures performed with an average of 8.2/patient (range: 5-12). The total in-patient hospital stay averaged 61.6 days (20-107 days) and in patient costs averaged $62,174.43/patient (range: $33,535.06-$143,847.45). Overall hospital cost averaged $1,009.32/day. Follow-up averaged 47.8 months (range 32-85 months), with an average time to union of 4.4 months. Fusion rate and muscle flap success was 100%. Although fusion and eradication of infection in this specific group of patients was possible, significant functional and psychosocial disability remained. Eight of eleven patients had significant pain, difficulty with stairs, and limited ambulation. All changed jobs or were unemployed. Patients with open grade IIIB tibiotalar injuries with significant bone loss may therefore benefit from early amputation. A multicenter randomized clinical outcome study is needed.
An operation is described in which a free vascularized fibular graft with a peroneal cutaneous flap is used for tibio-talo-calcaneal fusion and simultaneous skin coverage in treatment of comminuted open fractures of the talus and the calcaneus involving large skin loss. Nine months postoperatively, the tibio-talo-calcaneal arthrodesis was successful, with good coverage of the skin defect on the medial aspect of the sole. One year 7 months postoperatively, the patient is free of pain and able to walk with full weightbearing on the foot.
Seventeen patients with 18 open talar fracture-dislocations or total dislocations of the talus were reviewed to determine the functional outcome and incidence of infection. Seven of 18 feet (38%) developed infection. Infection was associated with extrusion of the talar body through the open wound (p < 0.025). Final follow-up was achieved in 13 of 17 patients (14 of 18 feet) at an average of 7 years and 4 months after injury. According to the Boston Children's Hospital ankle grading system, the overall results were considered excellent in one, good in five, fair in two, and failures in six feet. The data suggest a greater proportion of failures in the infected group compared with the non-infected group (p = 0.05).
A case of medial subtalar dislocation associated with fracture of the posterior process of the talus is described. Although this injury pattern is uncommon, it is important to recognize the associated fracture, as it involves a weightbearing articular surface. In this case, the flexor hallucis longus also prevented anatomic closed reduction necessitating open reduction and internal fixation.
We present two cases of traumatic total extrusion of the talus, leaving no soft-tissue attachment. The management of this rare injury is controversial. These cases were managed by reimplantation of the tali. The tali revascularised and survived without collapse. One patient developed posttraumatic osteoarthritis of the ankle.
Seven fractures of the neck of the talus were internally fixed using a lag screw inserted through the posterior tubercle. This followed closed reduction under fluoroscopic control in five cases with moderate displacement, whereas open reduction was performed in two cases with dislocation of the talar body. The fractures healed in 2 to 3 1/2 months. Clinical results, evaluated between 2 and 7 years after fracture, were excellent in three cases and good in four. Osteonecrosis of the talar body occurred in two cases: in one it was followed by revascularization without bone collapse; in the other it was followed by partial collapse of the body. Although the method described does not give full protection against osteonecrosis, it appears to have definite advantages over conventional methods of treatment.
A report of an unusual fracture of the lateral dome of the talus. The lateral fragment was displaced upwards into the inferior tibiofibular joint. Reduction was achieved by open reduction without internal fixation, and resulted in satisfactory union of the fracture without deformity or loss of joint function.