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Unicameral bone cysts are uncommon in the foot. When they do occur, they must be differentiated from a variety of other benign lesions. The author describes a unicameral bone cyst of the talus, and its surgical management. The patient returned 15 years later with complaint of mild ankle joint arthrosis, although recurrence of the cyst was not demonstrated.
The mechanism of second-degree external rotational injury of the ankle, with fracture of the lower end of the fibula, is discussed with reference to experiments on an anatomical model. It is concluded that with this type of injury there is lateral displacement of the talus because the deltoid ligament is ruptured, but there is no diastasis of the inferior tibiofibular syndesmosis. The results of conservative treatment of 10 patients with second-degree external rotational injury of tha ankle are reviewed.
A retrospective study of the arthroscopic treatment of osteochondral lesions of the talus in 25 patients was conducted. The follow-up period ranged from 1 to 4 years with an average of 2 years. Of the 25 patients, 20 could recall a history of injury. The diagnosis could be made by standard anteroposterior and lateral X-rays in 22 out of 25 patients. The standard anteromedial and anterolateral portals were usually sufficient. Patients with stage I and II lesions did well uniformly. In the 16 patients with stage III and IV lesions, good results were obtained in 12 and fair in 4. Morbidity was minimal.
Twelve patients with sixteen feet showing true congenital vertical talus were treated at Children's Hospital of Pittsburgh by excision of the navicular as an adjunct to open reduction. When these children were evaluated two to fifteen years after naviculectomy, all were asymptomatic and fully active. Except for one Achilles-tendon lengthening (three months after naviculectomy), none had required further surgical procedures. Fifteen feet were examined in detail. Assessed on an anatomical basis, three of the feet were excellent; seven, good; four, fair; and one, poor. The best results were obtained in the patients who were eighteen months old or younger at the time of operation.
Osteonecrosis of the talus secondary to adrenal corticosteroids is rare. The pathophysiology of the disorder is controversial. This is a report of bilateral talar necrosis secondary to steroid medications in a 23-year-old male. Conservative methods of management of the condition are not altogether satisfactory. Bilateral ankle replacement in this case resulted in alleviation of pain and improvement of function.
We evaluated the results of arthrodesis that had been performed for arthrosis of the ankle and osteonecrosis of the talus in nineteen patients. Twelve patients were men, and seven were women. The mean age of the patients was thirty-four years (range, nineteen to fifty-eight years). The median interval between the injury and the index operation was twenty-one months (range, six to 408 months). The arthrodesis was performed at the level of the ankle only in three patients and in both the ankle and the subtalar joint in sixteen. External fixation was used in thirteen patients, internal fixation was used in four, and no fixation was used in two. Supplemental bone graft from the iliac crest was used in fourteen patients, and local bone graft was used in five. The mean duration of follow-up was six years (range, two to fifteen years). The clinical result was excellent in seven patients, good in six, fair in three, and poor in three. Union was achieved in sixteen ankles, but it was delayed in one of them. Complications occurred in four patients: one had a tibial stress fracture, one had an infection at the site of a non-union, and two had malalignment in plantar flexion. Overall, the arthrodesis was successful in these patients. The use of rigid fixation and bone-grafting had a rate of success approximating that reported for primary arthrodesis in patients who do not have avascular necrosis.
Between 1985 and 1996, our Service treated 18 cases of osteochondritis dissecans of the talus in children and adolescents. The lesion is more frequent during childhood than previously thought. Different theories about the etiology of the lesion and the various treatments used are discussed. The outcome was satisfactory in most cases. We consider that, with the exception of type IV Berndt and Harty lesions, preliminary treatment should be conservative, which gave good results in our study. Surgical treatment should be reserved for patients with an unsatisfactory evolution with orthopaedic treatment, with lesions with thick sclerotic edges, or for patients with loose intraarticular fragments.
Bone marrow oedema syndrome of the talus is a rare cause of pain in the foot, with limited options for treatment. We reviewed six patients who had been treated with five infusions of 50 microg of iloprost given over six hours on five consecutive days. Full weight-bearing was allowed as tolerated. The foot score as described by Mazur et al was used to assess function before and at one, three and six months after treatment. The mean score improved from 58 to 93 points. Plain radiographs were graded according to the Mont score and showed grade-I lesions before and after treatment, indicating that no subchondral fracture or collapse had occurred. MRI showed complete resolution of the oedema within three months. We conclude that the parenteral administration of iloprost may be used in the treatment of this syndrome.
A dog and a cat suffered talocalcaneal luxation with plantar displacement of the head of the talus. Each case was associated with luxation of the talocentral joint and subluxation of the calcaneoquartal joint. The collateral ligaments were not significantly disrupted and this made it technically difficult to reduce the luxations. However, after open reduction, the luxations were inherently stable and a positional screw provided long-term stability. Both animals returned to their previous level of activity with no detectable signs of lameness.
The submitted retrospective investigation analyzes a group of 108 casualties with injuries of the skeleton of the foot who were hospitalized in the years 1985-90. Excluded was the group of patients with fractures of the talus and calcaneus because they consider problems of these fractures specific. The structure of the group is influenced by the specialty of the authors' workplace--i.e. treatment of multiple injuries. The characteristic of the group, the mechanism of the injury, data concerning time, a summary of the diagnoses, primary treatment and complications are summarized in tables. Twenty-eight of the patients were checked after a time interval of 24-89 months (mean 51.5 months) following injury. X-ray revealed in all cases consolidation of the fracture, however, frequently in a dislocated position. The basis for evaluation was therefore the clinical examination: in 20 patients the finding was evaluated as normal (physiological); permanent sequelae recorded in eight patients are listed. Subjective evaluation was in most instances more favourable than the objective finding, in particular in patients with multiple injuries. The authors recommend to pay appropriate attention even to so-called "minor" injuries which must be also properly treated at the right time.
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