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At least 19 recordsLinked to original sources
PubMed1997

[Homologous talus replacement after talectomy in infection and septic talus necrosis. Experiences with 3 cases].

Severe infections of the talus are often associated with complete septic collapse of the talus. In this connection, open fractures with defects or significant comminution have a bad prognosis is as far as reconstruction of the talus is concerned. In the Department of Traumatology, Braunschweig, in 1995 three patients (all male, average age 35.3 +/- 10.2 years) were treated with cancellous bone grafting after talectomy performed because of infection and complete septic collapse of the talus. In two of these cases third-degree open total dislocation of the talus had been sustained. The third patient came to us after undergoing arthroscopy of the ankle region in another hospital. In each case a fulminating infection was the outcome. Following a step-by-step algorithm, in a first step urgent radical debridement with talectomy was done. To maintain approximation between the tibia and calcaneus on one side and the os naviculare on the other, the bony defect was filled with PMMA chains and the external fixateur technique was used for immobilization during treatment of the infection. After second- and third-look procedures a free flap was grown for soft tissue coverage within the first 10 days. After 17.6 +/- 3.3 days the talus was replaced with a cancellous bone graft, combined with double arthrodesis in two cases, and external fixation for the next 4-5 weeks. In the third patient a triple arthrodesis was done. At follow-up after an average of 12 months (range 8-17 months), the bone graft with arthrodesis had been completely integrated in all cases. All patients are free of symptoms in normal life. In the case of severe open fractures of the talus with significant comminution combined with infection and septic bone collapse conservation of the talus is often impossible. The combination of homologous cancellous bone grafting and arthrodesis after talectomy is therefore a good method of keeping any decrease in the function of the foot to a minimum.

Adult↗
PubMed1992

Open total dislocation of the talus with extrusion (missing talus): report of two cases.

Two different methods of treatment for open dislocation of the extruded talus without soft tissue attachments (missing talus) were examined. In case 1, a 20-year-old man sustained an open total dislocation of the talus due to a motorcycle accident. The missing talus was found within 3 hr and replaced after thorough washing and debridement. Weightbearing was permitted at 20 weeks; however, the density of the talar body increased in the x-ray and nonweightbearing status was resumed. Reexamination at 2 1/2 years revealed that there was joint space narrowing on the x-ray and decreased pain with ambulation; the patient had returned to his job. In case 2, a 26-year-old man sustained an open total dislocation of the talus with a severe crush wound and impaired circulation to the foot. After thorough washing and debridement of the wound, the calcaneus and distal end of the tibia were aligned. The missing talus was found 3 days later, but not replaced. Weightbearing was allowed on the affected foot at 2 months; however, the patient felt pain at the joint surfaces and arthrodesis was consequently performed. At 2 1/2 years, the patient had a 4.0-cm leg length discrepancy in the involved extremity, but felt no pain when walking. Although reduction of the talus is ideal to preserve function and length of the extremity, several complications can occur. A review of literature on open total dislocation of the talus with extrusion was performed.

Adult↗
PubMed1998

[Post-traumatic ischemia of the talus. Is talus necrosis unavoidable?].

50 patients following talar fractures type Marti 2, 3 and 4 during the years 1972-1993, could be analysed retrospectively. Evaluated factors effecting posttraumatic avascular necrosis of the body of the talus are: type of fracture, age of the patient, additional fracture of the medial malleolus and time of non weight bearing. The Hawkins sign is reliable to show vitality in the body of the talus. We could see vascular impairment in 51% of all Marti 3 fractures and in 100% of all Marti 4 fractures. Patients with a concomitant fracture of the inner malleolus showed positive influence on the blood supply of the talus. In this case the ligamentum deltoideum and the ramus deltoideus of the arteria tibialis posterior remained intact. In addition to this the prognosis was better in young patients. A long period of non weight bearing could not preserve vitality of the talus. Necrosis of the talus did only appear in 34% of the Marti 3 and in 51% of the Marti 4 fractures. This means that early anatomic reconstruction of the talus is necessary. Primary arthrodesis of the ankle joint and talectomie are not up to date.

Adolescent↗
PubMedDate not supplied

[Frontal talus cleft--talus bipartitus].

To our knowledge, only three patients with a frontal split of the talus have been reported so far. We report on a sixteen year old patient who had some discomfort and restriction of movement in the ankle joint. X-ray examination showed an articular link between the ankle and subtalar joint. As regards the etiology, trauma, avascular necrosis, accessory bones and abnormal ossification were not evident. With respect to the phylogenesis of the foot skeleton, the frontal split of the talus may represent an atavistic malformation of the human foot. This is in contrast to the current hypothesis of a duplicated ossification in the talus.

Adolescent↗
PubMed1998

Squatting facets on the neck of the talus and extensions of the trochlear surface of the talus in late Byzantine males.

Remodelling of bone occurs in response to physical stress. Habitual squatting is associated with modifications of the neck of the talus (squatting facets) and its trochlear/malleolar surfaces (trochlear extensions), and individual populations exhibit different incidences of these modifications that reflect their lifestyle. The occurrence of talar modifications was therefore investigated in a population of late Byzantine (13th century AD) adult male skeletons. Lateral squatting facets occurred most frequently (37.7%), but medial (0.6%), combined (0.6%) and continuous (gutter-like) facets (0.6%) were also observed. Lateral (8.0%), medial (10.9%) and continuous (lateral/central/medial) extensions (4.6%) of the trochlear surface were all present in the late Byzantine population. There was no evidence of side dimorphism. The occurrence of lateral squatting facets in the late Byzantine population was greater than that reported for modern Europeans, but similar to that reported for some populations of modern Indians. The frequency of occurrence of trochlear extensions in the late Byzantine population was substantially less than in modern Indian populations, but similar to modern Europeans. Therefore, it is unlikely that precisely the same factors determine the expression of squatting facets and trochlear extensions.

Adult↗
PubMed1998

Traumatic extrusion of the talus (missing talus).

Complete dislocation of the talus is an extremely rare injury. We report on a case that was treated according to a surgical technique described by Günal et al. According to this technique, a pseudarthrosis is created between the tibia and the calcaneus by transposing and fixing the medial malleolus laterally and displacing the entire foot anteriorly. The result was considered to be initially unsatisfactory. At the 2-year follow-up examination, the outcome was considered to be satisfactory. This was attributed to preservation of motion and stability in the new mortise.

Adult↗
PubMedDate not supplied

Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions.

A retrospective study of 22 ankles in 22 patients with osteochondral talar dome lesions between 1975 and 1983 has indicated that surgical treatment yields superior results to conservative therapy. Thirteen male and 9 female patients, ages 9 to 72 years, average age 28 years, showed 10 medical lesions (Berndt and Harty classification (stage I (one); stage II/III (nine)) and 12 lateral lesions (stage II/III (5), stage IV (7)). Examination follow-up on 19 patients (86%) has averaged 24 months. The initial diagnosis seen retrospectively on x-rays was missed 43% of the time by emergency room physicians. A history of trauma was verified in 100% of the lateral lesions and 80% of the medial talar dome lesions. Of the 22 ankles, 14 lesions were isolated injuries, while 8 had concomitant fractures, lateral ligament, or peroneal tendon damage. Surgical treatment consisted of removal of the osteochondral fragment, curettage, and drilling of its bed. Two distinct surgical approaches were utilized. Lateral dome lesions were approached through the standard anterolateral incision, while medial dome lesions were approached through the anterior tibial tendon sheath with grooving of the anteromedial distal tibia articular surface. The medial approach allowed the somewhat posteriorly placed medial lesions to be reached, negating the need for a medial malleolar osteotomy and postoperative immobilization. On follow-up, no untoward ankle arthrosis was noted as a result of the grooving of the anteromedial distal tibia. Nineteen of the 22 patients had surgical therapy with 79% excellent or good, 21% fair, and no poor results. Five of the eight patients who elected prolonged conservative therapy finally had surgery. Of the three remaining patients conservatively treated, there were two fair results and one poor result.

Adolescent↗
PubMed1978

Surgical excision of an os talus secundarius: a case report.

Os talus secundarius is a relatively rare developmental abnormality of the talus; it is characterized by its location on the lateral aspect of the talus. This secondarily developed talus dramatically limits the range of motion of the ankle and subtalar joints. Differential diagnosis between talus secundarius and talus accessorius can usually be made radiographically. Talus secundarius secures itself to the lateral body of the talus by either a synchondrosis or synostosis and usually forms a set of articulations with the fibula, the superior lateral surface of the calcaneus, and a portion of the body of the true talus. Talus accessorius, however, is usually on the medial side of the talus and may form in the deltoid ligament. Talus accessorius is similar to the intercalary sesamoid bone between the external malleolus and the talus.

Adult↗
PubMed1979

Gross and histological abnormalities of the talus in congenital club foot.

Gross and histological abnormalities were demonstrated in a club-foot talus from a boy with multiple congenital anomalies who died when he was nine days old. Both tali were studied, the one from the club foot and the one from the normal foot. The gross anomalies involved the smaller size of the club-foot talus and the increased medial deviation of a stunted, misshapen head and neck region. Serial histological sections of both tali allowed for a three-dimensional geometric appreciation of both bones and an assessment of the nature and extent of histological and cytological features. The ossification center of the club-foot talus was absolutely and relatively smaller than that of the normal talus. It was eccentrically positioned, being more lateral and anterior than that of the normal talus. The marked histological abnormalities seen in the head and neck region of the club-foot talus involved extensive breaching of the endochondral sequence by vessels. The posterior aspect of the endochondral sequence and ossification center was normal. The extra-osseous and intra-osseous blood supply of the two tali was normal with the exception of the increased and irregular breaching of the endochondral sequence in the club-foot talus. This study demonstrates histological abnormalities in the head and neck region of the club-foot talus, which was most abnormal grossly. The eccentric position of the secondary ossification center as well as its related vascular abnormalities do not support a theory of developmental arrest of the talus but appear sufficiently abnormal to support the theory of a primary defect in the cartilage anlage. Clinically, one must bear in mind that early open reduction of the talocalcaneal navicular joint in a foot such as this would have served to reposition the navicular onto a talus that still was structurally abnormal.

Clubfoot↗
PubMedDate not supplied

Central pseudodefect of the talus: a potential ankle MR interpretation pitfall.

PURPOSE: The purpose of our study was to outline the MR features of the central pseudodefect of the talus (a normal finding that can simulate an osteochondral lesion on ankle MR studies), assess the prevalence of the central pseudodefect of the talus, and provide insight into the origin of this misleading MR appearance. METHOD: We retrospectively evaluated 31 ankle MR studies in 10 asymptomatic volunteers and 21 consecutive patients for the presence of the central pseudodefect of the talus. None of the patients had a history of trauma to the ankle. The signal, size, and shape of the pseudodefect were documented in each patient. The sagittal images were cross-referenced with the axial and coronal images in all patients in whom the central pseudodefect was identified. RESULTS: Six volunteers (60%) and 13 patients (62%) showed a curvilinear band in the middle third of the talus on far medial sagittal images, consistent with the central pseudodefect of the talus. The band measured 8-15 x 3-8 mm (mean 11 x 4 mm) and was hypointense on T1 and STIR pulse sequences. In two cases, the pseudodefect was subchondral; in the rest, it was found a few millimeters below the articular surface. On cross-referenced axial and coronal images, the band corresponded to the talar insertion site of the deep tibiotalar fibers of the deltoid ligament. CONCLUSION: The central pseudodefect of the talus is a common finding that is produced by the insertion of the tibiotalar fibers of the deltoid ligament into the talus. Familiarity with its appearance is necessary to avoid misinterpreting it as an osteochondral lesion of the talus.

Adult↗