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PubMed2002

Fresh osteochondral grafting in the treatment of osteochondritis dissecans of the talus.

We present a review of the literature on classification and treatment of osteochondral defects of the talus. We report the case of an isolated Berndt and Harty grade II lesion treated with a fresh osteochondral allograft. We believe that fresh allograft osteochondral grafting of the talus is an excellent technique for symptomatic Berndt and Harty grade II or higher lesion of the talus without significant tibiotalar arthritis. In selected patients, this procedure can provide excellent functional results.

Adolescent↗
PubMed1992

[Long-term results of talus fractures].

In a retrospective study we analysed 29 operative treated fractures of the Talus. The classification of Marti and Weber has been used in this study. The incidence of necrosis was 17% of the group III and IV and that one of arthritis 27%. There was no infection in our series. We doubt that a longterm non weight-bearing with a caliper brace has an effect on the outcome of a necrosis of the Talus. The evidence of the Hawkins' sign on the ap-radiograph at 6-8 weeks is a good and simple parameter of the vitality of the Talus.

Adolescent↗
PubMed2004

Osteochondral defects of the talus treated with autologous bone grafting.

We reviewed, retrospectively, 13 patients who had undergone open anterograde autologous bone grafting of the talus for symptomatic osteochondral defects of the dome of the talus. The mean age of the seven men and six women was 38.4 years. The defects included the full thickness of articular cartilage, extended through the subchondral plate and were associated with subchondral cysts. Six patients (46%) were clinical failures requiring further surgery. Of the remaining seven, functional outcome results were obtained at a mean of 51.9 months after surgery. The mean outcome scores for the Musculoskeletal Outcomes Data Evaluation and Management System foot and ankle questionnaire and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale were 87.0 and 84.3, respectively. There was an overall 46.2% patient satisfaction rate. We believe that the technique of autologous bone grafting presented should be used with extreme caution, when considered as the primary treatment for the adult patient with a symptomatic advanced osteochondral defect of the talus.

Adult↗
PubMed1992

Complete lateral dislocation of the talus without fracture.

A pure total dislocation of the talus from all its surrounding joints without a concomitant fracture is an extremely rare injury. Because of an inability to reduce this talus dislocation by closed methods, we performed an open reduction and stabilization with Steinmann pins. At 2-year follow-up, our patient had good functional and good roentgenographic results with no posttraumatic avascular necrosis of the talus or posttraumatic arthritis. To our knowledge, this is the first report regarding complete talar dislocation without an associated fracture.

Adult↗
PubMed2005

Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT?

Our aim in this prospective study was to determine the best diagnostic method for discriminating between patients with and without osteochondral lesions of the talus, with special relevance to the value of MRI compared with the new technique of multidetector helical CT. We compared the diagnostic value of history, physical examination and standard radiography, a 4 cm heel-rise view, helical CT, MRI, and diagnostic arthroscopy for simultaneous detection or exclusion of osteochondral lesions of the talus. A consecutive series of 103 patients (104 ankles) with chronic ankle pain was included in this study. Of these, 29 with 35 osteochondral lesions were identified. Twenty-seven lesions were located in the talus. Our findings showed that helical CT, MRI and diagnostic arthroscopy were significantly better than history, physical examination and standard radiography for detecting or excluding an osteochondral lesion. Also, MRI and diagnostic arthroscopy performed better than a mortise view with a 4 cm heel-rise. We did not find a statistically significant difference between helical CT and MRI. Diagnostic arthroscopy did not perform better than helical CT and MRI for detecting or excluding an osteochondral lesion.

Adolescent↗
PubMed2005

[Retrograde osteochondral grafting for osteochondral lesion of the talus: a new technique eliminating malleolar osteotomy].

Osteochondral grafting is one of the most effective treatment options for osteochondral lesions of the talus. However, the necessity for a medial malleolar osteotomy is the major drawback of the technique. This report presents a case treated with retrograde osteochondral grafting that eliminated the need for a medial malleolar osteotomy. An osteochondral lesion of the medial talus was detected in a 49-year-old woman. Under arthroscopic guidance, the talus was entered from the sinus tarsi region to establish a tunnel extending to the lesion. An osteochondral graft taken from the ipsilateral knee was inserted into the distal end of the tunnel and was advanced to the joint surface. Postoperative computed tomography scans showed that the graft completely filled the tunnel and provided congruency with the articular surface. Details of this technique are described.

Arthroscopy↗
PubMed2006

Osteosarcoma of the talus: a case report.

The reported incidence of osteosarcoma of the foot is very low. Osteosarcoma of the talus is extremely rare and few cases have been reported in the literature. The clinical findings are not typical, and osteosarcoma of the talus can be easily misdiagnosed, resulting in a delay in proper treatment. We report the case of a patient with osteosarcoma of the talus, from a series of 120 osteosarcomas treated at our hospital between 1966 and 2002.

Adult↗
PubMed1988

Total dislocation of the talus. Case report with a 13-year follow up and review of the literature.

Simultaneous dislocation of the talus from the tibiotalar, talocalcaneal, and talonavicular joints is uncommon and usually occurs from considerable violence. Total dislocation of the talus is frequently an open injury, or the skin may be tented over the dislocated talus leading to skin slough. Infection and avascular necrosis may follow. Treatment options include closed or open reduction, talectomy, and arthrodesis. The following case and literature review illustrate some of the problems encountered and factors that influence the outcome of this injury.

Adult↗
PubMed1986

An unusual fracture of the talus associated with a bimalleolar ankle fracture. A case report and review of the literature.

A 53-year-old man sustained a fall from 1.25 m, injuring his hindfoot and ankle. Roentgenographic examination demonstrated a displaced vertical fracture through the neck of the talus with dislocation at the subtalar and tibiotalar joints (Hawkins Group III) and an ipsilateral bimalleolar fracture. Prompt anatomic reduction of the talus and bimalleolar fracture with rigid internal fixation was performed. Roentgenograms three years postinjury confirmed solid union of all fractures. Avascular necrosis of the talus had not occurred. Minimally disabling post-traumatic arthritis as both the ankle and subtalar joints was the only sequela. Only four similar injuries seem to have been reported previously in the literature. Despite the generally high incidence of avascular necrosis in Hawkins Group III talar neck fractures, none of these four cases developed this complication. A possible explanation is that with the presence of ipsilateral bimalleolar fracture, there is preservation of the extraosseous vascular supply that accompanies the deltoid and talofibular ligamentous complexes.

Ankle Injuries↗
PubMedDate not supplied

Congenital vertical talus and its familial occurrence: an analysis of 36 patients.

Thirty-six patients (57 feet) showing congenital vertical talus were treated at the St. Louis Unit of the Shriners Hospital between 1958 and 1978. A high incidence of congenital hip dislocatiom, arthrogryposis, congenital hypoplasia of tibia and CNA disorders was noted as associated abnormalities. These patients are classified in 3 groups: (I) primary isolated form (16 patients); (II) associated form without neurological deficit (12 patients); (III) associated form with neurological deficit (8 patients). Fifty per cent of the patients with primary isolated form had positive family history of foot deformities in their first degree relatives. Familial incidence of congenital vertical talus was observed in 2 families studied. Genetic factors may play an important role in the etiology of the primary isolated form of congenital vertical talus. The current treatment is a one-stage open reduction of the talonavicular dislocation, combined with a posterior release. A subtalar bone block is often imperative to maintain correction. Cast correction alone has never succeeded as the definitive treatment of this condition.

Female↗
PubMed1984

Congenital vertical talus: classification with 69 cases and new measurement system.

Sixty-nine cases of congenital vertical talus (CVT) were classified into five groups in association with (1) neural tube defects or spinal anomalies, (2) neuromuscular disorders, (3) malformation syndromes, (4) chromosomal aberrations, and (5) idiopathic CVT unassociated with any of the systemic conditions described above. Forty-four cases of idiopathic CVT were subclassified into four groups: (5A) intrauterine molded or deformed cases, (5B) cases of digitotalar dysmorphism associated with contractile finger abnormalities and genetic inheritance, (5C) patients whose close relatives had CVT or oblique talus (OT) deformity, and (5D) cases unassociated with any skeletal deformity or genetic inheritance. The talar and Calcaneal axis--first metatarsal base angles (TAMBA and CAMBA) are introduced, which enable us to describe not only the obliquity of the talus and calcaneus but also the severity of the dislocation of the talonavicular joint and the contracture of the tendo Achilli. The changing point from flexible OT to rigid CVT is TAMBA of about 60 degrees and CAMBA of 20 degrees, and there are many borderline cases of CVT that could be treated conservatively. For the typical CVT, open reduction should be carried out as promptly as possible if 3 months of corrective casting in extreme equinovarus fails to reduce the TAMBA to 50 degrees.

Abnormalities, Multiple↗
PubMedDate not supplied

An unusual case of primary osteosarcoma of the talus.

An osteosarcoma of the talus occurred in a 21-year-old man. The tumor had been mistaken for a fibrosarcoma, but its osteogenic nature was demonstrated by multiple sectioning of the entire talus. Nineteen months after amputation the patient died from pulmonary metastases. Osteosarcoma in the talus seems not to have been previously reported.

Adult↗
PubMed1981

[Study of the talus and calcaneus using microdurometry, penetrometry and compression].

The authors give the results of various methods such as hardness micrometry, indentation tests and the radiographic study of fracture patterns, which they have applied to the talus and to the calcaneus. It appeared to them that: --these techniques outline the phenomenon of rupture behaviour of both talus and calcaneus; --the talus behaves as a fragile type of material whereas the calcaneus is of the intermediate type. The authors therefore think that these methods can be of great interest in a better understanding of the biomechanical properties of bone.

Biomechanical Phenomena↗
PubMed1995

Controversies in treating talus fractures.

Controversies of talus fractures are related to the rare incidence of these fractures and the even more sparse, clinically based, objective research examining treatment outcomes. This article outlines various talus fracture types, treatment, and treatment controversies. A discussion section summarizing treatment controversies of talar neck fractures, the most common talus fracture, is also included.

Adult↗
PubMed1994

Fracture of the posterior process of the talus associated with subtalar dislocation: report of a case.

Although subtalar dislocation is not common in foot trauma, fracture of the entire posterior process of the talus is even rarer. The concomitant injury of a subtalar dislocation associated with a fracture of the posterior process of the talus has not yet been reported in the medical literature. A 52-year-old woman involved in a traffic accident had her right foot twisted into an inversion deformity. An X-ray revealed a medial subtalar dislocation associated with a fracture of the entire posterior process of the talus. Tomography demonstrated that the posterior process was incongruent to the ankle and the subtalar joints. The subtalar dislocation was treated with a closed reduction. The fracture of the posterior process was treated with an open reduction and internal fixation. After the anatomic reduction of both injuries, the patient recovered and returned to her previous activities.

Accidents, Traffic↗
PubMedDate not supplied

"Snowboarder's fracture": fracture of the lateral process of the talus.

BACKGROUND: As physicians caring for patients who sustain snowboarding ankle injuries, we have noted that fracture of the lateral process of the talus occurs frequently. The incidence of this fracture, however, is very low in other accounts of ankle injuries. We report a case of fracture of the lateral process of the talus and review the pertinent literature of this injury. METHODS: A literature review was performed using MEDLINE files from 1966 to the present. We found additional references from the bibliographies of available reports. RESULTS AND CONCLUSIONS: Physicians caring for snowboarders should look specifically for fracture of the lateral process of the talus in a snowboarder with a lateral ankle or foot injury. This fracture can mimic a lateral ankle sprain, yet the fracture is easily missed on plain radiographs of the ankle. Because displaced or comminuted fractures can cause long-term disability, primary care physicians and specialists alike need to be aware of the association of this fracture with snowboarding.

Adult↗
PubMedDate not supplied

Conservative management of pes valgus with plantar flexed talus, flexible.

The type of flat foot that we have called pes valgus with plantar flexed talus, flexible, was treated in children with the Helfet heel seat or the UCBL shoe insert. In follow-up examination of 71 cases for periods longer than one year, 79 per cent of the patients showed that the UCBL shoe insert and the Helfet heel seat improved the clinical and roentgenographic appearance of the foot. The Helfet heel seat is recommended in cases where the plantar flexion angle of the talus is 35 to 45 degrees and the UCBL shoe insert in those cases of plantar flexion of the talus greater than 45 degrees.

Adolescent↗
PubMed1996

[Computerized tomography of osteochondral diseases of the talus dome].

The definition "osteochondritis dissecans" of the talus improperly includes a variety of diseases involving the chondral surface of the talus dome and the relative subchondral bone. To investigate the CT diagnostic potentials in the study of these conditions, 35 patients complaining of a "painful ankle" were examined with plain radiography and axial and direct paracoronal CT over a 2-year period. Twelve patients were then examined with double contrast CT arthrography with air and iodated contrast agents. CT diagnostic accuracy was assessed evaluating the following parameters: the presence and extent of the subchondral bone fragment, the presence of residual bone fragment attachment at the lesion base or its intraarticular dislocation, the presence of subchondral bone cysts, of chondral surface lesions and, finally, of capsular and ligamentous damage. All the patients with CT findings of osteochondral conditions of the talus dome were submitted to arthroscopic examination/treatment and/or surgical arthrotomy. Baseline CT exams accurately depicted all the lesions, except for early (grade I) lesions. Moreover, the administration of intraarticular contrast agent (CT arthrography) increased the diagnostic accuracy in articular cartilage studies. Therefore, the authors believe baseline CT on the orthogonal planes to represent an effective tool for the staging of osteochondral talar lesions and for accurate treatment planning.

Adolescent↗