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At least 37 records · Page 2Linked to original sources
PubMed2006

Bone stress injuries of the talus in military recruits.

The purpose of the present study was to assess the incidence, anatomic distribution, and nature of fatigue bone stress injuries of the talus in military recruits based on magnetic resonance imaging (MRI). Military recruits referred to MRI examination due to exercise-induced ankle and/or foot pain were identified from the MRI archives. MR images of cases with bone stress injury findings in the talus were retrospectively re-evaluated concerning the anatomic location and type of the bone stress injury. During 96 months, fifty-one consecutive recruits displayed bone stress injuries of the talus in the population base of 117,149 person-years, yielding an incidence of 4.4 (3.2-5.5)/10,000 person-years. Bilateral injuries were seen in five of the patients. Of the 56 bone stress injuries, 40 occurred in the head, 15 in the body, and 5 in the posterior part of the talus. In four cases, both the head and the body were affected. Solitary, the talus was affected in 12 cases. In 44 cases, a stress injury was also present in other tarsal bones. Assessing the severity of the bone stress injury, a grade I-III injury was found in 46 and a grade IV injury with a fracture line in 10 of the cases. Injuries of the upper part of the body were associated with calcaneal stress injuries in 78% of the cases (P=0.03), and injuries of the head of the talus were associated with stress injuries in the naviculare in 60% of the cases (P=0.04). Age, sex, height, weight, body mass index, or physical fitness failed to reach statistical significance as risk factors for fatigue bone stress injuries of the talus. On MRI, the majority of the bone stress injuries of the talus were revealed in the head. A grade IV injury was discovered in 18% of the cases; in the remaining 82%, only grade I-III injuries were ascertained. In all locations, the lower grade bone stress injuries dominated. This study established the incidence of fatigue bone stress injury of the talus and indicated that these injuries are rare but not unseen in military recruits.

Adolescent↗
PubMed2004

[Talus fractures--fractures of the most important tarsal bone].

The talus is the key bone of the foot due to its location between the ankle and the subtalar joints. Through the flexion and extension of the ankle joint, the talus is the "propulsive bone" situated at the root of the first ray and the hallux. Through the subtalar and talo-navicular joints, the talus allows the foot to be "suspended" using a fancy spring mechanism involving ligaments and tendons. The talus thus transmits forces through two important joints without any direct muscular constraint. The talo-calcaneo-navicular joint may be called the "coxa pedis" due to the anatomical and functional similitudes with the coxofemoral joint ("coxa pelvis"). Fractures of the talus are rare. Talus fractures can be classified in "central" and "peripheral" fractures. Central fractures occur through a strong axial blow provided that the ankle and coxa pedis are locked by extrinsic muscular contraction. Peripheral fractures instead occur in an extreme position of the ankle or the coxa pedis, with a subluxation or complete dislocation of one or more of those joints. Central fractures produce a bony solution of continuity in between at least two of the ankle, subtalar and talo-navicular joints. Peripheral fractures mostly do implement joint surfaces which are sheared off. Aim of treating talus fractures is precise and stable reduction of the fragments because most often, the fractures cross the articular layers. The surgical approaches are critical, especially in displaced central fractures, because the reduction may require visual control all around the bone. There are three approaches which might be used as single approaches or combined simultaneously: the anteromedial approach along the subtalar joint from the navicular to the retro-malleolar region, the anterolateral approach centered on the sinus tarsi (Ollier) and the postero-lateral approach (Gallie). In many cases, a joint distraction device may help visualization of the different joint spaces as well as assist reduction of dislocations. Early joint mobilization, without weight bearing may be very profitable for good functional results. Aseptic necrosis (AVN) of the talus do not need special care if asymptomatic. On the long run, open operative arthrolysis might be added to the eventual removal of implants to considerably improve the results.

Adult↗
PubMedDate not supplied

Central pseudodefect of the talus: a potential ankle MR interpretation pitfall.

PURPOSE: The purpose of our study was to outline the MR features of the central pseudodefect of the talus (a normal finding that can simulate an osteochondral lesion on ankle MR studies), assess the prevalence of the central pseudodefect of the talus, and provide insight into the origin of this misleading MR appearance. METHOD: We retrospectively evaluated 31 ankle MR studies in 10 asymptomatic volunteers and 21 consecutive patients for the presence of the central pseudodefect of the talus. None of the patients had a history of trauma to the ankle. The signal, size, and shape of the pseudodefect were documented in each patient. The sagittal images were cross-referenced with the axial and coronal images in all patients in whom the central pseudodefect was identified. RESULTS: Six volunteers (60%) and 13 patients (62%) showed a curvilinear band in the middle third of the talus on far medial sagittal images, consistent with the central pseudodefect of the talus. The band measured 8-15 x 3-8 mm (mean 11 x 4 mm) and was hypointense on T1 and STIR pulse sequences. In two cases, the pseudodefect was subchondral; in the rest, it was found a few millimeters below the articular surface. On cross-referenced axial and coronal images, the band corresponded to the talar insertion site of the deep tibiotalar fibers of the deltoid ligament. CONCLUSION: The central pseudodefect of the talus is a common finding that is produced by the insertion of the tibiotalar fibers of the deltoid ligament into the talus. Familiarity with its appearance is necessary to avoid misinterpreting it as an osteochondral lesion of the talus.

Adult↗
PubMed1996

Stress fracture of the body of the talus in athletes demonstrated with computer tomography.

PURPOSE: This article describes a series of four previously unreported stress fractures of the body of the talus. CASE SUMMARY: The four patients presented with ankle pain of gradual onset for periods of three weeks to 12 months. Radioisotope scans in all four patients showed identical pictures of markedly increased uptake in the region of the body of the talus. Computed tomographic scan images were also similar showing a distinct fracture line through the posterolateral aspect of the body of the talus extending into the subtalar joint. All four patients were treated differently ranging from rest to surgery, but no treatment appears totally successful. DISCUSSION: A single case of stress fracture of the neck of talus has previously been reported in a runner, but no previous cases of stress fracture of the body of the talus have been reported. The mechanism may be that in the presence of excessive subtalar pronation and plantar-flexion, the lateral process of the calcaneus impinges on the concave posterolateral corner of the talus. No treatment appeared totally successful but the authors would recommend a six week period of non-weight-bearing rest. RELEVANCE: The diagnosis of stress fracture of the body of the talus should be considered in the athlete who presents with gradual onset of ankle pain.

Adult↗
PubMed1983

[Treatment of talus fractures. Control study of 262 treated cases].

It is useful to subdivide talus fractures in central and peripheric ones, as serious complications have to be expected only in the first group. Under 207 central talus fractures the feared talus necrosis has been found after operative treatment as well of collum as of corpus-trochlea fractures in about 21% of the cases, after conservative treatment in 11 respectively 19%, while posttraumatic arthrosis appears in over 50% (talus fractures with side injuries). The isolated central talus fracture has a better prognosis. The earlier the exact anatomical reposition is realized, the better are the results. Open talus fractures are threatened by infection. The so called central talus fractures--open or closed--are surgical emergency cases and so they have to be treated.

Adolescent↗
PubMed1998

Architecture of the cancellous bone of the human talus.

The trabeculae of the cancellous bone are formed along the direction of the lines of stresses to which a bone is subjected. The talus sustains the weight of the body and transmits the weight in different directions (i.e., the calcaneus and navicular). The aim of the present study was to investigate the architecture of the cancellous bone of the talus to understand the mechanism of transmission of force within the bone. Twenty-five dry, macerated tali of adult male humans were used to study the trabecular architecture. In a few bones, serial longitudinal (parasagittal), transverse (coronal), and horizontal sections were cut; in other bones, the trabecular bone was exposed by removal of cortical bone. Trabecular architecture was studied by dissection microscope and by taking radiographs of the slices. The body of the talus consisted of vertical, parallel plates arranged posteroanteriorly. This kind of orientation of the plates facilitates the transmission of weight, when the tibia rolls posteroanteriorly on the trochlear surface during walking. The trabecular architecture in the head of talus consisted of semiarched plates running parallel to each other. The vertical limb of these semiarched plates were situated above the middle and anterior calcaneal facets on the plantar surface of the head, whereas the horizontal limbs of the arches were deep to the navicular articular surface of the head. The vertical plates of the body and semiarched plates of the head were interconnected by a meshwork of irregularly arranged trabecular bone of the neck. The architecture of this meshwork was such that it could facilitate the change in the direction and nature of force. In conclusion, the part of compressive force, acting vertically downward on the body of the talus during standing, was converted to tensile force in the neck, and its direction was made perpendicular to enable this force to go toward the head of the talus. In a similar manner, the semiarched pattern of plates in the head facilitated the change in the direction of the force, at the end of the stance phase, from the downward (toward calcaneus) to the forward (toward navicular) direction.

Heel↗
PubMed2004

Relative motions of the tibia, talus, and calcaneus during the stance phase of gait: a cadaver study.

The motions of the tibia, talus, and calcaneus during walking were analyzed three-dimensionally using a dynamic cadaver model that recreates the stance phase of walking. Rigid marker clusters were attached to each of the three bones, and the rotations of the talus and calcaneus with respect to the tibia and the calcaneus with respect to the talus were analyzed for eight right cadaver feet. The talus rotated primarily in plantarflexion/dorsiflexion about the talocrural joint, with an average range of 18 degrees +/- 4.7 degrees. The calcaneus began in inversion and internal rotation with respect to the tibia, moved into the neutral position at 28% of the stance phase and rotated primarily in plantarflexion from that point onward. Rotation of the calcaneus with respect to the talus at the subtalar joint occurred about all three axes, with approximately 5 degrees of relative dorsiflexion and 7 degrees of relative internal rotation. After 25% of stance, the talus and calcaneus moved together as one body into plantarflexion, providing a rigid lever as toe-off was approached.

Aged↗
PubMed2006

Outcomes of stress fractures of the talus.

BACKGROUND: Stress fractures of the talus are rare, and only a few small studies have been published. In the absence of follow-up studies, the outcomes of these injuries are unknown. HYPOTHESIS: Traumatic fractures of the talus frequently heal poorly, and stress fracture healing might remain inadequate. The purpose of this study was to determine the outcome of stress fractures of the talus treated in the authors' institution with reduced exercise and nonweightbearing. STUDY DESIGN: Case series (prognosis); Level of evidence, 4. METHODS: Patients with a diagnosed stress fracture in the talus by magnetic resonance imaging between April 1997 and March 2005 were recalled for a follow-up inspection by an orthopaedic surgeon, magnetic resonance imaging, and plain radiographs to determine the outcome of the injury. RESULTS: One of the 9 patients in our sample declined the invitation, leaving 8 patients with 9 stress fractures in the talus who participated in the follow-up examination. Five patients displayed subchondral degeneration and edema near the original injury area in the follow-up magnetic resonance imaging. In 2 patients, the degeneration was also visible on the plain radiographs. Three patients had mild and 2 moderate symptoms after the mean follow-up time of 45 months (range, 12-74 months). No serious complications in the healing process were seen. CONCLUSION: Stress fractures of the talus do not seem to seriously damage the foot. In a middle-term follow-up, however, minor to moderate symptoms and radiological degeneration of the injured area prevailed in roughly half of the patients.

Adult↗
PubMed1991

[Fractures of the talus].

Peripheral fractures of the talus, such as fractures of the posterior and lateral process, need no special therapy. Larger fragments with dislocation require open reduction and screw fixation. Small flake fractures with stability of the joint can be removed arthroscopically, but larger fractures should be repositioned with K-wires, small screws. Ethipin or fibrin sealant. Dislocated fractures of the head of the talus should be reduced and fixed by screws or K-wires. Fractures of the neck of the talus with anteromedial or lateral dislocation can be treated by closed reduction and external fixation, irreducible fractures by open reduction and screw fixation. Fractures of the neck and body of the talus with dorsal dislocation or subluxation in the talonavicular joint require osteotomy of the internal malleolus, open reduction and screw fixation. Comminuted and open fractures of the body of the talus are treated by minimal osteosynthesis with K-wires or external fixation. In necrosis of the talus, revascularization using iliac crest bone with vascular pedicle seems to be successful. In arthrosis cases, triple arthrodesis is the best solution.

Bone Screws↗
PubMed1989

[Fractures and dislocations of the talus].

Some of the peculiarities of the anatomy of the talus are of special interest: the lack of muscle insertions, the vulnerability of the blood supply, and the fact that about 60% of the surface is covered by hyaline cartilage. This implies that most of the fractures are intra-articular. In 1983, the results of 262 talus fractures were published. Kuner and Lindenmaier found post-traumatic arthritis in about 50% of the cases. A subdivision of peripheral and central fractures is useful; complications like avascular necrosis are found in about 18% of fracture cases of the central talus. Magnetic resonance imaging may be helpful in the early diagnosis of talus necrosis. Hawkins' sign in an anteroposterior roentgenogram after 6 or 8 weeks of fracture dislocation and non-weight-bearing shows that subchondral atrophy is present in the dome of the talus. This excludes the diagnosis of avascular necrosis. Absence of subchondral atrophy in the early months and then later density of the dead bone and atrophy of the surrounding bones imply avascular necrosis. Dislocations around the talus without fractures are classified into three types: talocrural dislocation (i.e., luxatio pedis cum talo), subtalar dislocation (i.e., luxatio pedis sub talo), and the extremely unusual total dislocation of the talar body. The dislocations should be reduced promptly to avoid breakdown of the skin and distal circulatory compromise.

Fracture Fixation, Internal↗
PubMed1995

[Injury analysis of pediatric talus fractures].

Fractures of the talus are very rare in children. The present paper analyzes the treatment and long-term follow-up of 11 talus fractures in children over a period of 20 years (1974-1994). There were 5 fractures of the talus neck, 3 flake fractures, 1 depressed fracture of the talus head, and 2 lesions at the trochlea of the talus. Two fractures not previously described in the literature are presented. Treatment was conservative in all nondisplaced fractures. The displaced lesions were treated by compression screws and K-wire fixation of articular surface fractures. In 9 of the 11 fractures healing with good functional results, though arthrosis of the talocalcanean joint was present in 6 and partial necrosis of the talus, in 2. There is no difference between children and adults in the diagnosis and selection for operative treatment.

Adolescent↗
PubMed1994

[The treatment of severe talus fracture-dislocations and peritalus dislocations].

Twenty-eight cases with severe talus fracture-dislocation and 17 cases with peritalus dislocations were treated and were followed up with an average of 7 years and 2 years plus 5 months for these two groups respectively. Comparison of the results of treatment in the cases with severe talus fracture-dislocations with 3 different methods (reduction and immobilization, total talus resection and arthrodesis) was made. Satisfactory result was obtained only in cases treated with arthrodesis, therefore, this method should be considered at first in the treatment of severe talus fracture-dislocations. Impaction of intraarticular fragments and soft tissues are usually the indications of open reduction for peritalus dislocations. Severity of injury accompanied with intraarticular fractures, and open injury are the factors influencing the prognosis. Different from severe talus fracture-dislocations, talus avascular necrosis did not occur in cases with peritalus dislocations.

Adolescent↗
PubMed2005

Incomplete sagittal fracture of the talus in 11 racehorses: outcome.

REASONS FOR PERFORMING STUDY: Little information exists regarding talus fractures in the horse and there have been no previously published case series of racehorses diagnosed with incomplete sagittal fracture of the talus. OBJECTIVE: To describe the diagnosis, treatment and post injury performance of horses with incomplete sagittal fracture of the talus. METHODS: Medical records of 11 racehorses (8 Standardbreds and 3 Thoroughbreds) admitted between January 1992 and January 1999 were reviewed. Subject details, anamnesis, results of lameness examination, radiographs and nuclear scintigraphic findings were evaluated. Racing performance was assessed by comparing pre- and post injury race records. RESULTS: Nuclear scintigraphic examination, performed in 8 of the 11 horses, revealed focal increased radiopharmaceutical uptake in the proximal aspect of the affected talus. Fractures could best be seen on dorsal 10-20 degrees lateral-plantaromedial oblique radiographs; all had raced pre-injury. All horses were treated conservatively and follow-up information was available for 8 horses, of which 7 raced after injury. Performance in 3 horses was improved, in 1 it was unchanged and in 3 horses performance declined. CONCLUSIONS: Horses with incomplete fracture of the talus have a good prognosis for return to racing after conservative management. POTENTIAL RELEVANCE: Incomplete sagittal fracture of the talus should be considered as a cause of hindlimb lameness in racehorses. Further research is necessary to determine the pathophysiology of these fractures.

Animals↗
PubMed2006

Computer-assisted minimally invasive treatment of osteochondrosis dissecans of the talus.

OBJECTIVE: Revascularization of areas of necrosis in the talus and stimulation of bone regeneration whilst protecting the talar hyaline cartilage using computer-assisted minimally invasive drilling or retrograde cancellous bone relining of the osteochondrotic zone. INDICATIONS: Osteochondrosis dissecans of the talus, Berndt & Harty stages I-III. CONTRAINDICATIONS: Osteochondrosis dissecans of the talus, Berndt & Harty stage IV. General contraindications such as poor skin and soft-tissue conditions or poor general condition. SURGICAL TECHNIQUE: Before the operation: fitting a removable cast for the ankle (ankle fixation cast), then computed tomography of the ankle with the ankle fixation cast fitted. Planning the site of the central Kirschner wire in the talus using a navigation system in the laboratory. Adjusting and locking the aiming device. Intraoperative procedures: fitting the sterilized ankle fixation cast. Retrograde placement of the 2.4-mm Kirschner wire through the locked aiming device. Check on the position of the Kirschner wire using an image intensifier. Arthroscopy of the ankle; further parallel holes may then be drilled depending on the findings or retrograde cancellous bone grafting may be performed by harvesting cancellous bone from the calcaneus. POSTOPERATIVE MANAGEMENT: For retrograde drilling/parallel drilling: 1 week of partial weight bearing at 30 kg. For retrograde cancellous bone grafting: 4 weeks of partial weight bearing at 15 kg, then 2 more weeks of partial weight bearing at 30 kg. Physiotherapy. RESULTS: From December 1999 to January 2005, 41 patients with osteochondrosis dissecans of the talus were selected for computer-assisted treatment by retrograde drilling or retrograde cancellous bone grafting. In 39 of the 41 patients, the osteochondral lesion-as verified by postoperative magnetic resonance imaging (MRI)-was accessed, i.e., the drilled hole led to the lesion. In two cases, irreparable flaws in the materials were discovered intraoperatively, so that the above method was only performed on 39 patients. The 1-year results for the first 15 patients treated with retrograde drilling/parallel drilling and concomitant ankle arthroscopy without retrograde cancellous bone graft are presented here based on the follow-up MRI (position of drill hole, assessment of vitality of the area of osteochondritis) and a clinical score. The four women and eleven men were, on average, 34.1 years old (14-55 years). In the radiologic comparison of the pre- and postoperative stages of the osteochondritis dissecans, 46.7% of patients showed an improvement in the Berndt & Harty stage. 40.0% showed the same osteochondrosis dissecans stage in the postoperative MRI, and in 13.3% it deteriorated by one grade. In the clinical follow-up examination, the AOFAS Score averaged 88.9 points.

Adolescent↗
PubMed1997

[Radiologic and histologic observations in central talus fractures].

In a prospective study of central fractures of the talus, radiological data (plain radiography, CT, MRI) were scrutinized in terms of correlation with histological findings (biopsy taken at time of screw removal). The study looked at nine fractures in eight patients aged 14-48 years. There was one fracture of Hawkins type I, one fracture of type II, four fractures of type III, and three corpus fractures. All were operated on within 24 h after injury; seven had screw fixation, two had adaptation with K wires. The patients were kept non-weight-bearing for 14-53 weeks. Duration of follow-up was 2 years or more in all but one patient. In the final radiograph the talus was intact in four patients, while four showed a partial avascular collapse; in one patient, a partial collapse was doubtful. Histology taken 16-52 weeks after injury showed osteocyte-free original bone in all cases, with deposition of new bone varying in extent. Hawkins sign was partially positive in six patients, positive in one, and negative in one. Decalcification as well as fracture healing can be better followed by CT than by plain radiography. MRI appeared normal in five patients, partially pathological in two, and abnormal in one. A positive Hawkins sign and normal signal behavior can be seen as prognostically favorable signs. However, in the case of a central talus fracture, even with a favorable course osteonecrosis of at least a part of the talus with gradual replacement by new bone occurred. Vascularization of the central talus seems to be disturbed more frequently than is reflected radiologically.

Adolescent↗
PubMed2000

Arthroscopic management of osteochondral lesions of the talus: results of drilling and usefulness of magnetic resonance imaging before and after treatment.

Since the advent of operative ankle arthroscopy and magnetic resonance imaging (MRI) specific treatment of osteochondritis dissecans of the talus has progressed rapidly. Drilling is still the treatment of choice in early stages of osteochondritis dissecans of the talus. Rear-entry guides and preoperative planning with MRI have led to better results with this kind of treatment. Within 5 years, 42 patients (26 male and 16 female) underwent arthroscopic treatment of osteochondritis dissecans of the talus, 22 underwent percutaneous drilling, 13 cancellous bone grafting, 4 refixation, and 3 curettage. The average age of the patients was 28 years (range, 11 to 53 years). A clinical score system was used in a clinical and MRI follow-up of 19 of the patients with K-wire drilling. Up to 100 points are given in the categories pain, stability/insecurity, efficiency/pain-free walking distance, gait, differences in circumference, range of motion, and power. There was a history of trauma in 31 of the 42 patients. The majority of lesions (24 cases) were localized at the lateral talus, and these patients all had trauma. In 11 of the 18 lesions at the medial talus, there was no evidence of trauma. The 19 patients in the follow-up achieved an average of 87 points. K-wire drilling represents the chief component of early stages with intact or partially fractured cartilage surface, whereas arthroscopically controlled cancellous bone grafts after curettage are used in grade II stages only. Results of K-wire drilling are not worse than those of cancellous bone grafts; this is attributable to a generous perforation of the sclerosis. This has contributed to an improved preoperative diagnosis with MRI.

Adolescent↗
PubMedDate not supplied

Total extrusion of the talus: a case report.

Total extrusion of the talus without recovery of the bone is a very unusual injury. The authors present a case of a 25-year-old man who sustained an open total enucleation of the talus in a motorcycle accident. The talus was not recovered at the scene of the accident. An immediate tibiocalcaneal stabilization was performed by using an external fixator. In the postoperative period, a polymicrobic infection was observed and treated with parenteral antibiotics. Nine months after injury, the patient developed an infection of both the empty space and the distal third of the tibia. A wound debridement with tibial sequestrectomy and insertion of gentamicin-impregnated polymethylmethacrylate beads was performed. Three months later, after multiple negative bacteriologic examinations, a tibiocalcaneal arthrodesis with staples and autogenous bone graft was performed. Because of a pseudoarthrosis, the patient underwent a revision of the arthrodesis by retrograde tibiocalcaneal nailing, achieving clinical and radiographic success. The definitive treatment of total enucleation of the talus is still controversial because of its rarity and the high rate of complications, such as avascular necrosis, osteomyelitis, and ankle stiffness. In this case, without recovery of the talus, retrograde nailing afforded good stability by bypassing the bone defects.

Accidents, Traffic↗
PubMed2001

Combined fracture of the talus: Arthroscopic treatment.

The purpose of this article is to report the treatment and short-term results of a combined fracture of the talus treated arthroscopically. A 29-year-old man sustained an anterolateral osteochondral grade III fracture of the talus dome associated with a coronal fracture of the body of the talus. This injury was reduced and fixed arthroscopically using cannulated screws. The patient returned to his daily style of living after 3 months time. One year later, the patient remains asymptomatic. Radiography showed neither signs of osteonecrosis nor osteoarthritis of the talus at the 1-year follow-up. Therefore, arthroscopic surgery could be an alternative treatment for this kind of talus fracture.

Activities of Daily Living↗