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[Treatment of flake fracture of the talus].

This is a report on 18 osteochondral lesions of the talar dome after sprained ankles and ruptured lateral collateral ligaments of the ankle. They were classified according to Berndt & Harty. The treatment of choice in recent flake fractures is the reduction and glueing with fibrine. Very good results were obtained according to Weber. The recommended treatment of ancient flake fractures frequently occurring to elder patients is the removal of the fragment and the drilling of the subchondral bone.

Adolescent↗

[Isolated bone tuberculosis of the talus. Case report].

In view of the rarity of isolated bone tuberculosis a case is reported here. Clinical and laboratory findings are also described. The patient was a nine-year-old boy. We were unable to find any other case of isolated tuberculosis reported in the literature.

Child↗

Surgical treatment of talus fractures: a retrospective study of 80 cases followed for 1-15 years.

We retrospectively reviewed 79 patients (80 talar fractures) operated on between 1994 and 1997. The average follow-up was 6 (1-15) years. 15 patients had a Marti/Weber fracture type I, 14 patients a type II, 32 patients a type III, and 19 patients a type IV fracture. 46 patients suffered a fracture of the talar neck, Hawkins type I in 10 patients, type II in 18, type III in 17 and type IV in 1 patient. 18/23 patients directly placed in our department were operated on within 6 hours of admission. Primary arthrodesis of both the ankle and subtalar joint was performed twice. Secondary arthrodesis of the ankle joint was done in only 3 patients. Combined secondary arthrodesis of the ankle and subtalar joint was performed in 5 and arthrodesis of the talonavicular joint in 1 patient. According to the Hawkins score, 35/80 feet achieved good/very good function versus 43 with the Mazur score. Radiographs showed ankle or subtalar arthrosis in two thirds of the patients. A normal range of motion was achieved in 18 ankle and 19 subtalar joints. The overall rate of talar necrosis was 9/80 fractures.

Adolescent↗

Anatomical reconstruction of malunited talus fractures: a prospective study of 10 patients followed for 4 years.

BACKGROUND: Malunions or nonunions after displaced talar fractures cause significant disability. Salvage procedures such as corrective arthrodesis do not restore normal foot function. METHODS: Between 1994 and 2002, we treated 10 patients (aged 15-50 years) who had painful malunions with secondary anatomical reconstruction, at a mean of 1 year after sustaining displaced fractures of the talar body or neck. 5 patients were classified as type I (malunion and/or residual joint displacement), 2 as type II (nonunion with displacement) and 3 as type III (malunion with partial avascular necrosis, AVN). Correction was by an osteotomy through the malunited fracture or removal of the pseudarthrosis. Internal fixation was achieved with screws and additional bone grafting if necessary. RESULTS: No wound healing problems or infections were seen. Solid union was obtained without redislocation in all cases, with no signs of development or progression of AVN. At a mean of 4 (1-8) years after reconstruction, all patients were satisfied with the result--except one patient who required ankle fusion 8 years after reconstruction. The mean AOFAS Ankle Hindfoot Score increased from 38 to 86 (p < 0.001). INTERPRETATION: Secondary anatomical reconstruction with joint preservation leads to considerable functional improvement in painful talar malunions. Partial AVN does not preclude good to excellent functional results. The quality of the bone stock and joint cartilage (rather than the time from injury) appears to be important for the choice of treatment.

Adolescent↗

Anterolateral subluxation of the talus after overlooked dislocation of the tibialis posterior tendon.

We report a case of tibialis posterior tendon dislocation into the disrupted ankle mortise between the tibia and fibula that was overlooked in the initial operative treatment of a fracture dislocation of the ankle with syndesmosis disruption. Recurrent widening of the ankle mortise prompted revision surgery where the posterior tibialis tendon dislocation was discovered to be the cause of secondary joint subluxation. The course of the tendon was corrected and the anatomy of the joint restored. One year after revision there is a good clinical result, however early posttraumatic osteoarthritis of the tibiotalar joint is seen radiologically.

Adult↗