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PubMed1998

Fractures of the lateral process of the talus: two case reports and a comprehensive literature review.

Fractures of the lateral process of the talus are frequently overlooked and should be considered in the differential diagnosis of patients with acute and chronic ankle pain. Early diagnosis is emphasized in all series reviewed in the literature to prevent long-term complications. Thorough radiographic evaluation is necessary to determine the need for operative vs. nonoperative management. Small nondisplaced fractures are treated with cast immobilization, whereas large or displaced fractures usually require open reduction and internal fixation. Comminution of fragments may necessitate surgical excision. To achieve the best possible results, a timely diagnosis is required, and it is our belief that early treatment has better overall results.

Adult↗
PubMed1999

Osteochondral lesions of the talus: a revised classification.

Osteochondral lesions of the talus present a numerically small but therapeutically significant problem to the foot surgeon. The diagnosis and investigation of such lesions have been greatly enhanced by modern high resolution magnetic resonance imaging capabilities, which have provided far greater detail of the pathological anatomy. We have reviewed our experience in this area and suggest a revised classification for osteochondral lesions appropriate to the detail available on magnetic resonance imaging scans. The cause of osteochondral lesions is also discussed.

Adult↗
PubMed1989

Demonstration of osteochondritis dissecans of the talus by coronal computed tomographic arthrography.

Ten cases of osteochondritis dissecans of the talus are reviewed. Coronal computed tomographic arthrography identified the precise location in each case and consistently revealed the extent of the lesion to be greater than that apparent on the plain radiographs. The talar cartilage over the lesion was shown to be thinned in four cases, deficient in two, and fissuring of the cartilage was demonstrated in four. Subarticular cysts were identified in all but two cases and contrast medium was shown to enter the cysts in two cases indicating a communication with the ankle joint. The aetiology and relevance of these findings to treatment are discussed.

Adult↗
PubMed1995

Fractures of the lateral process of the talus--the value of lateral tomography.

We present three cases of fractures of the lateral process of the talus, where routine anteroposterior and lateral radiographs showed an abnormality but were insufficient to assess the degree of bony injury, which is important for clinical management. Lateral tomography provided good diagnostic and anatomical detail. The diagnosis and treatment of this unusual and often missed fracture is discussed.

Adult↗
PubMed1979

The treatment of congenital vertical talus.

Operative correction of congenital vertical talus in nine feet in six patients is described. The operation consists of the comprehensive lengthening of the tendons in the foot and full peritalar release without excision of the navicular; it is performed through a dorsal transverse incision.

Child↗
PubMed1982

Osteochondritis dissecans of the talus. The late results of surgical treatment.

Thirty-five cases of osteochondritis dissecans of the talus, operated on between 1950 and 1978, were studied. Twenty-four were available for follow-up an average of 47 months later. Three standard surgical approaches were used, and the osteochondritic fragment removed. In some cases the base of the defect was drilled. Good results were obtained in 15 patients, and fair in nine. There were no poor results. It was concluded that the defect is caused by trauma; that early operation gives the best results, 12 months being the critical delay time; that drilling the base of the defect improves results; and that the sex of the patient and the location of lesion are of little significance.

Adolescent↗
PubMed1984

Primary subacute osteomyelitis of the talus.

In four children with primary subacute osteomyelitis of the talus seen one to five months from the onset of symptoms, the only constant complaints were of pain and a limp. All four were treated by curettage, immobilisation in plaster and appropriate antibiotics. All the bony cavities were healed within eight months of the operation and there were no growth disturbances nor any abnormalities of the adjacent joints.

Anti-Bacterial Agents↗
PubMed1985

Congenital vertical talus. The results of staged operative reduction.

Congenital vertical talus was diagnosed in 15 feet of 10 children, and was treated by operative reduction. Forefoot deformity was corrected first, using anterolateral soft-tissue release on 11 feet, and manipulation alone in four feet. After prolonged immobilisation in plaster the affected feet had posterior release at the ankle and elongation of the calcaneal tendon. Clinical and radiographic examination at follow-up 15 months to 21 years later showed that a satisfactory outcome had been achieved in 12 of the 15 feet.

Child, Preschool↗
PubMed1985

Talus partitus. A case report.

A 15-year-old girl presented with a four-year history of pain in the left ankle. There was no known trauma, only a postnatal soft tissue infection which had healed with no sequelae. Radiographs showed that the talus consisted of two large fragments and one small one.

Adolescent↗
PubMed1987

Osteochondral fractures of the talus. A long-term follow-up.

Sixty-eight patients with 71 osteochondral fractures of the talus were evaluated an average of 7.5 years after the onset of symptoms to determine which factors influenced the final result. It was found that the type of fracture was the most important; delay in treatment also affected the result adversely. A scheme of treatment for each type of fracture is proposed.

Adolescent↗
PubMed1993

A new technique of talectomy for severe fracture-dislocation of the talus.

We report a new technique of talectomy for patients with Hawkins group III fracture-dislocation of the talus. Talectomy is performed through a medial incision, the foot is displaced anteriorly, and the fractured or osteotomised medial malleolus is moved laterally and fixed to the tibia with a malleolar screw. Full weight-bearing is allowed after six weeks. In four patients at 36 to 57 months after operation the results were excellent in three and good in one, with no pain or early evidence of degenerative arthritis in the remaining joints of the foot.

Adult↗
PubMed2003

Arthroscopic treatment of osteochondral lesions of the talus.

We reviewed, retrospectively, 65 patients who had undergone arthroscopic treatment for osteochondral lesions of the talus. The 46 men and 19 women with a mean age at operation of 34.25 years, were followed up for a mean of 3.5 years. The medial aspect was affected in 45 patients and the lateral aspect in 20. All the lateral lesions and 35 (75%) of the medial lesions were traumatic in origin. Medial lesions presented later than lateral lesions (3 v 1.5 years) and had a much greater incidence of cystic change (46% v 8%). At follow-up, 34 patients had achieved a good result, and 17 and 14 fair and poor results, respectively. Of the 14 poor results, 13 involved medial lesions. Cystic lesions had a poor outcome in 53% of patients. Excision and curettage led to better results than excision and drilling of the base. Further arthroscopic surgery for patients with a poor result was disappointing. There was no association between outcome and the patient's age.

Adolescent↗
PubMed2006

Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus.

The treatment of osteochondral lesions of the talus has evolved with the development of improved imaging and arthroscopic techniques. However, the outcome of treatment for large cystic type-V lesions is poor, using conventional grafting, debridement or microfracture techniques. This retrospective study examined the outcomes of 50 patients with a cystic talar defect who were treated with arthroscopically harvested, cored osteochondral graft taken from the ipsilateral knee. Of the 50 patients, 45 (90%) had a mean good to excellent score of 80.3 (52 to 90) in the Karlsson-Peterson Ankle Score, at a mean follow-up of 36 months (24 to 83). A malleolar osteotomy for exposure was needed in 26 patients and there were no malleolar mal- or nonunions. One patient had symptoms at the donor site three months after surgery; these resolved after arthroscopic release of scar tissue. This technique is demanding with or without a malleolar osteotomy, but if properly performed has a high likelihood of success.

Adolescent↗
PubMed1979

Inherited congenital bilateral atresia of the external auditory canal, congenital bilateral vertical talus and increased interocular distance.

Six out of twenty descendants of a reportedly affected grandfather have congenital bilateral symmetrical and isolated subtotal atresia of the external auditory canal. Four of the six affected descendants have bilateral foot anomalies--two affected cousins having congenital vertical talus. All of the three affected boys in the third generation have increased interocular distance. Short fifth fingers, bilateral single transverse palmar creases, pyloric stenosis and congenital exotropia were found infrequently and are considered coincidental features. Apart from the atresia, oto-rhinolaryngologic examination, mental function, dermatoglyphics, IgA, kidney function and heart function of the affected descendants were all normal. The karyotype of four affected descendants examined was normal. An autosomal dominant inheritance with variable expressivity is suggested.

Abnormalities, Multiple↗
PubMed2004

C-arm-based mobile computed tomography: a comparison with established imaging on the basis of simulated treatments of talus neck fractures in a cadaveric study.

OBJECTIVE: To analyse the image quality and diagnostic effectiveness of a new C-arm-based 3D imaging method (C-arm-CT) for intraoperative evaluation of screw osteosyntheses adjacent to a peripheral joint. MATERIALS AND METHODS: Insertion of screws into four cadaveric specimens simulated the surgical treatment of talus neck fractures. Ten orthopedic surgeons and 10 radiologists evaluated X-ray, C-arm fluoroscopy, C-arm-CT and CT images. RESULTS: The best image quality was obtained with X-rays (p < 0.001), followed by C-arm fluoroscopy (2D) and CT, with the C-arm-CT (3D) being rated lowest (p < 0.001). The most correct diagnoses were obtained with CT and C-arm-CT (with no statistical difference between them), while C-arm-fluoroscopy was inferior (p < 0.001) and X-rays were the worst (p < 0.05). CONCLUSIONS: Even if the image quality of C-arm-CT is definitely inferior to that of CT, screw misplacements can be reliably detected using C-arm-CT. As compared to the current standard procedures (intraoperative fluoroscopy and postoperative radiography), C-arm-CT performed better. C-arm-CT is ideally suited to the intraoperative diagnosis of high-contrast inquiries like bone fragments and OS material, especially at the extremities. Coupling of the new 3D imaging to existing navigation systems is possible. C-arm-CT will support the further development and implementation of open and minimally invasive surgical procedures.

Bone Screws↗
PubMed1975

The arterial supply of the talus. A study on the relationship to experimental talar fractures.

After filling the arteries of the talus with contrast medium, fractures of the neck were produced to study the effect on these vessels. It was found that the ascending branches from the main arteries, arteria canalis tarsi and arteria sinus tarsi, were ruptured in all cases. The vessels in the fracture area were all sharply cut off. Without fracture displacement the surrounding arteries were remarkably intact, whereas with displacement these became affected by varying degrees of disruption. The vessels in the bone adjacent to the fracture remained intact.

Adolescent↗
PubMed1976

Aneurysmal bone cyst of the talus.

Aneurysmal bone cysts localized in the talus are extremely rare. Such a case is described and the histological findings are analysed in relation to those in aneurysmal cysts in general. The pathomechanism of the lesions is discussed.

Adult↗
PubMed1977

Fracture of the body of the talus.

Fifty-one patients with fracture of the body of the talus were seen at follow-up examination an average of 23 months after treatment. Osteonecrosis had developed in 8 out of 17 patients with displaced shearing or crush fractures of the trochlea. Malunion as well as subluxation predisposed to osteoarthrosis in the subtalar and talocrural joints. Thus, osteoarthrosis was present in 9 out of 21 patients without malunion, in 8 out of 16 patients with malunion, and in 11 out of 14 with malunion as well as subluxation. Judging from the nature of the complaints, the difficulties in rehabilitation, and the disability assessment, the prognosis was fairly grave, also after the small, usually non-displaced fractures of the posterior and lateral tubercles. Out of 20 patients with fractures of this type only 6 obtained almost complete relief from their symptoms, only 8 could go back to their previous work on a full-time basis, and 11 were assessed to be 10 per cent or more disabled. Fractures in the posterior and lateral tubercles must therefore be interpreted as links in more extensive injuries involving the subtalar joint and possibly the talocrural joint with associated injuries to articular cartilage, joint capsules, and ligaments.

Adolescent↗