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PubMed1988

[Talus necrosis and its treatment].

Aetiopathogenesis of the necrosis of the talus has not yet been definitely clarified, and neither has that of the other aseptic necroses. We were able to study the aetiopathogenesis, course of the disease and therapy in 20 of our own patients by follow-up; two of these developed necrosis of the talus in both feet. We definitely excluded patients suffering from osteochondrosis dissecans. Even though fracture of the talus is on the whole relatively rare, it remains the most frequent cause of necrosis of the talus. We also found talonecrosis after surgical correction of clubfoot, after Sudeck's disease (Sudeck-Leriche syndrome, Sudeck's atrophy or dystrophy), suppurative arthritis of the ankle joint, subtalar luxation and haematogenic osteomyelitis. Only few patients required surgery. In most cases a special boot constructed for arthrodesis patients proved sufficient. Each patient developed arthrodesis to a different degree. Depending upon the complaints and stiffening of the ankle joint or of the talo-calcanonavicular joint, the capacity of the patients to be gainfully employed was reduced by an amount between 20 and 30 per cent.

Adolescent↗
PubMed1985

Clinical evaluation of dogs after surgical and nonsurgical management of osteochondritis dissecans of the talus.

Osteochondritis dissecans of the medial aspect of the talus was diagnosed in 17 joints in 11 dogs. In 10 of the 11 dogs, intermittent lameness had persisted after initial diagnosis and therapy. Radiographs made during the initial examination showed a widening of the medial tarsocrural joint space, with osteophyte formation involving the medial and caudal tarsocrural joint. The follow-up radiographs showed greatest change in the increase in reactive bone formation, especially involving the medial and caudal aspects of the tarsocrural joint and the medial aspect of the talus. Arthrotomy for flap removal and curettage was performed on 11 joints; 6 joints did not receive surgery. After a mean period of 34 months following diagnosis, the dogs were examined clinically and the affected joints were radiographed. The degree of lameness, range of motion, and stability of the tarsocrural joint were graded for each limb. Radiographic determinants that were assessed included: width of the medial tarsocrural joint space, medial tarsocrural osteophyte formation, lateral tarsocrural osteophyte formation, caudal tarsocrural osteophyte formation, medial talus osteophyte formation, lateral talus osteophyte formation, intertarsal osteophyte formation, subchondral sclerosis of the distal end of the tibia, presence of joint bodies, and periarticular soft-tissue thickness. On the basis of clinical and radiographic evaluations, the surgical procedures described in this report did not modify progression of osteoarthritic changes.

Animals↗
PubMed1982

[Therapy and results of traumatic cartilage-bone lesions of the talus (author's transl)].

Since the number of possibilities for causing injuries is great, lateral as well as medial talus-edge break-offs occur more often than diagnosed. However, by appropriately using all available diagnostic tools, it is possible to detect even these frequently discrete injuries. Fresh cartilage-bone chips of the talus should be fixed like other joint fractures primarily by screw osteosynthesis, bone-chip fixation, vicryl-sutures, or fibrin adhesives. Older cartilage-bone chips can often only be removed and the defect zone at the talus smoothed and reamed. We treated a total of 14 patients with talus-edge lesions. The therapy and results are reported in detail.

Adolescent↗
PubMedDate not supplied

Complete posterior dislocation of the talus. Case report and discussion.

Complete dislocation of the talus is an injury that is produced by a great magnitude of force, producing severe soft tissue injury, frequently vascular compromise, often with subsequent avascular necrosis. Complete posterior dislocation of the talus seems not to have been reported previously. The treatment in a 39-year-old man was designed on the basis of experience with antero-medial dislocation. Treatment ranges from attempted anatomical reduction to early arthrodesis of one or all of the articulations of the talus, with and without talectomy. No one method has shown to be superior to the others. Oen reduction is often unsuccessful, probably because of ankle malalignment. Avascular necrosis of the talus without collapse is not necessarily painful. In the present case talectomy and tibio-calcaneal fusion was performed one year after injury. The symptomatic results were good. Accurate anatomical reduction should be the aim of initial therapy. Definitive therapy can be designed to fit the requirements of the individual case.

Accidents, Traffic↗
PubMed1993

Osteosarcoma of the talus. A case report.

A 20-year-old man complained of increasing pain and swelling in the right ankle joint. Radiographs of the ankle demonstrated an ill-defined osteolytic lesion in the talus associated with a small, round bone formation just proximal to the neck of that bone. Histologic examination of the lesion showed osteoblastic osteosarcoma originating in the talus. Below-knee amputation was performed because of the peripheral location of the tumor and the close anatomic confines of the foot. A literature review demonstrated that the calcaneus and metatarsals are favorite sites of this tumor in the foot, with only one case in the talus. A second case of osteosarcoma in the talus seems to have not been previously reported.

Adult↗
PubMed1997

Complex fractures of the talus.

Injuries of the talus make up a significant proportion of complex foot and ankle injuries. The severity of these injuries is increasing because the availability and use of better safety equipment has allowed more people to survive serious accidents. Early rigid and accurate anatomic fixation lead to the best possible outcome for each category of talar injury. If osteonecrosis is suspected, titanium screws should be used for fixation to allow better postoperative follow-up. Treatment of osteonecrosis of the talus still depends mainly on clinical judgment, with the MRI providing more clinical data. The outcome of the osteonecrotic talus has not been established at this point. The approach to the talus depends on the judgment and skill of the surgeon; two approaches usually are indicated for more severe injuries. A CT scan is quite helpful for fractures of the talar body; preoperative planning and the judicious use of malleolar osteotomy with preservation of the deltoid artery are advocated. Tibiotalar and talocalcaneal motion have been altered as a result of talar fractures. Arthrosis of the subtalar joint depends on the degree of injury.

Fractures, Bone↗
PubMed1998

Intraosseous tophaceous pseudotumor in the trigonal process of the talus.

Primary gout with destructive tophaceous pseudotumor development rarely occurs in juvenile patients with asymptomatic hyperuricemia. An expansile, intraosseous tophaceous pseudotumor on the posterior process of the talus was verified in a 14-year-old boy with posterior ankle impingement and asymptomatic hyperuricemia. A review of the literature found no similar cases had been reported. The pathogenesis of this intraosseous tophaceous pseudotumor on the trigonal process probably was caused by the penetration of urate crystals from the periosteum into the posterior process of the talus. However, the time that this intraosseous tophaceous pseudotumor developed probably was close to the time that the second ossification center of the talus fused to the talus. Thus, it cannot be ruled out that the intraosseous tophaceous pseudotumor had formed during the fusion process of the second ossification center as a possible pathogenic mechanism in this unusual case.

Adolescent↗
PubMedDate not supplied

Injuries of the talus and its joints.

To understand the mechanism of injury and classify fractures of the talus requires knowledge of the anatomy of the hindfoot, its function and the nature of the traumatic forces. The talus has an irregular shape with articular surfaces for tibia, fibula, calcaneus and navicular. It functions as a complex universal joint between the leg and foot created by the ankle, sub-talar and midtarsal joints. Injury may disturb function and create serious disability. As in the femoral head, osteonecrosis is a serious problem after injury to the talus. The reason for this lies in a peculiar distribution of the arterial circulation which exposes it to some injuries, but not to others. To understand the mechanism of injury is to be better prepared to properly treat these injuries and to more accurately predict their consequences. Injury occurs as motion caused by an extrinsic force is applied to the part, and when the motion is forceful enough to overcome resistance. For the talus and its joints the mechanisms of injury are: extension, flexion, inversion, eversion, and compression. Rotation, medial and lateral, may be important in the production of fractures of the talar trochlea. Combinations of these mechanisms cause complex injuries.

Ankle Injuries↗
PubMed2005

Bony lesion recurrence after mosaicplasty for osteochondritis dissecans of the talus.

Autogenous osteochondral grafts have recently become popular for use in small, isolated, contained articular cartilage defects. We treated a 26-year-old man who had a cartilage defect measuring 10 x 20 mm in the anteromedial area of the right talus. We performed multiple osteochondral grafting of the lesion with medial malleolar osteotomy from a donor site in the ipsilateral knee joint. Two years after the operation, the patient's ankle pain recurred and the bony lesion in the talus also became osteolytic. Because we believed that only the cartilaginous portions of the osteochondral plugs grafted 2 years previously were fully fixed and viable, and that recurrence had occurred at the bony portions, at reoperation we performed curettage of the bony lesions and grafted iliac bone into the lesions with fenestration of the inferomedial ankle joint cartilage, not grafted plug cartilage. Therefore, probably because of overuse, the bony lesion in the talus had recurred 2 years after the first operation, but the grafted hyaline cartilage had survived. Autogenous osteochondral grafting into the talus, unlike the knee joint, should be done with care to ensure there is no sclerotic bone surrounding the lesion in patients with long-standing symptoms and recurrence of bony lesions.

Adult↗
PubMedDate not supplied

Impingement exostoses of the talus and fibula secondary to an inversion sprain. A case report.

Impingement exostoses of the talus and fibula following an inversion sprain is an uncommon sequela to the initial injury. Although a high frequency of symptomatic tibial and talar impingement exostoses have been reported, changes on the lateral side of the ankle are more subtle with significant roentgenographic findings rarely seen. The authors present a rare case of impingement exostoses involving both the talus and fibula simultaneously. Arthroscopy visualized the tibiotalar and talomalleolar articulations. It revealed opposing exostoses of the talus and fibula, necessitating surgical resection. Arthroscopy is recommended for difficult diagnostic problems of the ankle and an awareness of the condition of post-traumatic impingement exostoses of the talus and fibula.

Ankle Injuries↗
PubMed1995

[Congenital convex talus. Methods and results of a single-stage surgical correction].

PURPOSE OF THE STUDY: The aim of this study was to emphasize the anatomical particularities of congenital vertical talus. We propose a one stage operative procedure adapted to the deformities. MATERIALS AND METHODS: A retrospective study of 24 children with congenital vertical talus was conducted. An etiology was observed in 58 per cent of cases and 42 per cent were considered as idiopathic. From a radiological analysis of 39 feet, we precise the anatomical particularities. We used anteroposterior and lateral X-ray and lateral stress views with maximal plantar and dorsal flexion. Most of the lesions were localized in the midtarsal joint. The irreducibility of the talonavicular dislocation is the predominant lesion. It is usually associated with a disorientation of the cubocalcaneal joint. The articular surfaces are disorganized with a dorsal orientation. There is a variable amount of equinus deformity in the hindfoot. However the talocalcaneal divergence angle is nearly normal. The forefoot is most of the times in eversion but sometimes in inversion. PROCEDURE: All children were treated initially by physiotherapy. We recommend operative treatment for them between one to two years old. After a soft tissue release, the talonavicular dislocation and the hind foot equinus deformity is reduced simultaneously. The subtalar joint is respected and not opened. Retracted tendons may be an obstacle to the reduction. They must be lengthened if necessary especially the Achilles tendon, the peronei, the extensors and the tibialis anterior. Reduction is maintained by a K wire transfixing the midtarsal joint. RESULTS: Clinical results were difficult to evaluate. Out of 24 operated feet, a satisfactory outcome had been achieved in 15 feet. All were plantigrad and 18 had a good cosmetically aspect. The only bad result concerned an old case which was not operated by this technique. DISCUSSION AND CONCLUSION: Conservative treatment is usually unsuccessful in congenital vertical talus. Numerous procedures have been advocated for the surgical correction of this deformity. Some authors advised excision of the navicular, full open peritalar release or extraarticular talocalcaneal arthrodesis. These are often extensive procedures and most are performed in two stages. Recently, one stage operative procedure was proposed. It allows a good correction with the respect of the subtalar joint and a lower risk of talus avascular necrosis. Furthermore it is more adapted to the deformity with a less extensive scar and a better respect of the anatomy.

Arthrodesis↗
PubMed1976

The estimation of sex on the basis of the talus and calcaneus.

The present report records and describes sexual dimorphism of the talus and calcaneus in American Blacks and Whites from the Terry Collection housed in the Smithsonian Institution, Washington, D.C. The greater amount of sexual dimorphism was observed in the talus, where 81 percent of the study sample could be accurately sexed. Four discriminant functions based on measurements from the talus and/or the calcaneus allowed sexing 79 to 89% of the study sample accurately. The techniques developed were then applied to two North American Indian samples, and sex of the individuals in these samples was assessed with the same degree of accuracy.

Black People↗
PubMed1986

Osteoid osteoma and osteoblastoma of the talus. A report of 40 cases.

Forty patients with osteoid osteoma or osteoblastoma of the talus are presented. Clinical and radiographic findings, histologic features, and therapy of these lesions are discussed. The body of the talus was involved in two patients, all other lesions being located in the neck of the bone. Subperiosteal lesions accounted for 75% of cases, and medullary lesions for 25%. Thirty of the 40 lesions were paraarticular. Five radiographic appearances in the talus are discussed: subperiosteal target lesions of the neck (54%); medullary lesions of the neck (20%); subperiosteal radiolucent lesions of the neck (13%); medullary lesions of the body (5%); and exostotic osteoid osteoma of the talar neck (3%).

Adult↗
PubMed1988

Direct coronal computed tomography arthrography of osteochondritis dissecans of the talus.

Although radiographs, arthrography, tomography, and computed tomography can all be used to diagnose osteochondritis dissecans of the talus, these imaging methods may not demonstrate whether an undisplaced osteochondral fragment has any attachment to the articular cartilage or bony bed of the talus. As lack of such attachment is a relative indication for surgery, we studied the feasibility of using coronal computed tomography (CT) after double contrast arthrography to demonstrate attachment in four patients with osteochondritis dissecans seen on radiographs. Direct coronal CT arthrographic images showed intact articular cartilage in three patients. In the fourth patient, overlying cartilage was virtually absent and contrast tracked beneath the fragment, an appearance that correlated with arthroscopic findings of partial articular cartilage attachment and no union at the osteochondral fracture line. Our initial experience suggests that direct coronal CT arthrography clearly shows the state of attachment of the osteochondritic fragment to the talus.

Air↗
PubMed1977

[The importance of the radiological angle between talus and calcaneus in patients with congenital clubfoot (author's transl)].

A reduction of the angle between the longitudinal axes of talus and calcaneus in the lateral X-ray view of a clubfoot is a sign of persistent supination of the subtalar joint and not due to anatomical changes of the bone. Correction of this deformity by closed manipulation produces a normal angle between talus and calcaneus. The angle between talus and calcaneus can thus be used as a guide for adequate correction of the subtalar deformity.

Anthropometry↗
PubMed1989

Revascularization of a partially necrotic talus with a vascularized bone graft from the iliac crest.

A 16-year-old patient had a compound dislocation of the right talus. Following primary treatment, which included a subtaler screw arthrodesis, the talus developed clinical, radiological, and isotope scan signs of necrosis. In spite of a walking caliper to prevent weight bearing on the ankle, the talar articular cartilage of the ankle joint also showed signs of degeneration. The talus was revascularized with a vascularized corticocancellous iliac crest bone graft. Six months postoperatively, there were clinical, radiological, and bone scan signs of significant revascularization. The patient is free of pain and able to walk with full weight bearing on the foot.

Adolescent↗
PubMed2006

[Fracture of the neck of the talus in a child].

Fractures of the talus in children are rare. Repeated clinical examination and imaging techniques such as magnetic resonance imaging are often needed to establish a diagnosis. In case of the late recognition of talus fractures, catastrophic results may occur for the hind-foot. This case report presents a 5 year old boy with a non-displaced talus neck fracture with good outcome after minimally invasive osteosynthesis.

Ankle Injuries↗
PubMed2002

Transient bone marrow edema of the talus: MR imaging findings in five patients.

OBJECTIVE: To describe the MR findings of transient bone marrow edema (TBME) of the talus and to address the differential diagnostic considerations. DESIGN AND PATIENTS: The imaging findings of TBME of six tali were retrospectively reviewed in five patients with a clinical history of pain without trauma. Inclusion criteria were MR imaging findings that, when compared with clinical data and results of follow-up assessment, allowed the diagnosis of TBME. MR imaging, standard radiography, and bone scintigraphy were performed. The images were reviewed with particular attention to the pattern and distribution of abnormal marrow signal intensity as well as associated findings. RESULTS: In four cases the entire talus was involved, and in two cases only a portion of the bone was affected. No fractures were detected. MR imaging demonstrated diffuse decreased signal intensity of the marrow on T1-weighted images with corresponding increased signal intensity on T2-weighted images. In all six cases MR imaging detected associated findings, which included joint effusion and soft tissue edema. All patients improved clinically with conservative therapy over a period of 6 months to 1 year. CONCLUSIONS: Although unusual, TBME can involve the talus. Marrow edema without evidence of a fracture and in the absence of history of trauma is a characteristic MR imaging feature, allowing confident diagnosis and institution of conservative therapy.

Adult↗