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At least 19 recordsLinked to original sources
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↗
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↗
PubMed1991

[Fractures of the talus].

Peripheral fractures of the talus, such as fractures of the posterior and lateral process, need no special therapy. Larger fragments with dislocation require open reduction and screw fixation. Small flake fractures with stability of the joint can be removed arthroscopically, but larger fractures should be repositioned with K-wires, small screws. Ethipin or fibrin sealant. Dislocated fractures of the head of the talus should be reduced and fixed by screws or K-wires. Fractures of the neck of the talus with anteromedial or lateral dislocation can be treated by closed reduction and external fixation, irreducible fractures by open reduction and screw fixation. Fractures of the neck and body of the talus with dorsal dislocation or subluxation in the talonavicular joint require osteotomy of the internal malleolus, open reduction and screw fixation. Comminuted and open fractures of the body of the talus are treated by minimal osteosynthesis with K-wires or external fixation. In necrosis of the talus, revascularization using iliac crest bone with vascular pedicle seems to be successful. In arthrosis cases, triple arthrodesis is the best solution.

Bone Screws↗
PubMed1989

[Fractures and dislocations of the talus].

Some of the peculiarities of the anatomy of the talus are of special interest: the lack of muscle insertions, the vulnerability of the blood supply, and the fact that about 60% of the surface is covered by hyaline cartilage. This implies that most of the fractures are intra-articular. In 1983, the results of 262 talus fractures were published. Kuner and Lindenmaier found post-traumatic arthritis in about 50% of the cases. A subdivision of peripheral and central fractures is useful; complications like avascular necrosis are found in about 18% of fracture cases of the central talus. Magnetic resonance imaging may be helpful in the early diagnosis of talus necrosis. Hawkins' sign in an anteroposterior roentgenogram after 6 or 8 weeks of fracture dislocation and non-weight-bearing shows that subchondral atrophy is present in the dome of the talus. This excludes the diagnosis of avascular necrosis. Absence of subchondral atrophy in the early months and then later density of the dead bone and atrophy of the surrounding bones imply avascular necrosis. Dislocations around the talus without fractures are classified into three types: talocrural dislocation (i.e., luxatio pedis cum talo), subtalar dislocation (i.e., luxatio pedis sub talo), and the extremely unusual total dislocation of the talar body. The dislocations should be reduced promptly to avoid breakdown of the skin and distal circulatory compromise.

Fracture Fixation, Internal↗
PubMed1991

Posttraumatic necrosis of the talus: the Hawkins sign versus magnetic resonance imaging.

Magnetic resonance imaging (MRI) is reported to be more sensitive than plain radiographs, computed tomography, or radionuclide bone scanning in detecting osteonecrosis. Few cases of MRI scans falsely negative for osteonecrosis have been reported. A 36-year-old man with posttraumatic necrosis of the body of the talus proven by biopsy had three serial MRI scans that were interpreted as showing the talus to be viable. Eight weeks after injury, the plain radiographs did not show subchondral resorption of bone in the talus (Hawkins sign) and, thus, did correctly indicate necrosis. Most likely a non-union of the talus neck fracture resulted in the false-negative MRI scans.

Adult↗
PubMed1992

Functional, radiographic, and histologic assessment of healing of autogenous osteochondral grafts and full-thickness cartilage defects in the talus of dogs.

A circular (5.5 mm diameter) full-thickness cartilage defect was created on the medial ridge of the talus in 12 skeletally mature dogs. In 6 dogs, the articular surface of the lesion was repaired, using an osteochondral graft obtained from the ipsilateral manus. The graft (digit I, first phalanx, distal articular surface and diaphysis) was contoured to obtain a press fit in the drilled talar recipient site. In 6 dogs, the lesion was not treated and healed by fibrous tissue replacement. Functional assessment (lameness, hock range of motion, joint stability, joint crepitus, and mid-femoral muscle circumference) was completed before surgery and at postoperative weeks 2 through 20. Radiographic assessment (periarticular soft tissue width, joint space width, osteophyte formation, and graft incorporation) was completed before surgery and at postoperative weeks 0, 6, 12, and 20. To facilitate histologic assessment, tissues were stained with toluidine blue and H&E. Histologic assessment of the articular surface on the surgically treated talus, ipsilateral tibia, and contralateral talus was completed, using a modification of the Mankin grading system. Subchondral bone was examined to assess graft viability and incorporation. Analysis of the ordinal data was completed, using a Mann-Whitney rank sum test. All dogs were fully weight bearing by postoperative week 7. Dogs without grafts had significantly (P = 0.036) better clinical function at postoperative week 6. Significant difference in functional assessment was not evident at postoperative week 20. Immediate postoperative radiographic assessment revealed significant (P = 0.005) difference between nongrafted and grafted groups. Significant difference was not observed at postoperative week 6, 12, or 20. All grafts appeared radiographically incorporated by postoperative week 12. All grafts restored joint surface congruity, whereas 3 of 6 nongrafted lesions had poor articular congruity. Of 6 grafts, 4 partially retained normal hyaline cartilage, resulting in significantly (P = 0.014) lower Mankin grades. Significant histologic differences between groups were not apparent when the apposing tibia and control talus were examined. Talar reconstruction by use of a phalangeal osteochondral graft is a viable surgical procedure. These data indicate that normal articular and subchondral architecture are more closely approximated by osteochondral reconstruction than by fibrous tissue repair.

Animals↗
PubMedDate not supplied

Chondral and osteochondral lesions of the talus associated with capsuloligamentous lesions of the ankle joint.

The author reports 46 cases of chondral and osteochondral lesion of the talus observed in 256 patients treated surgically between 1974 and 1986 for capsulo-ligamentous lesions of the ankle joint. Four cases were observed in the 18 patients operated for pure lesion of the medial collateral ligament; the remaining 42 cases in the 238 patients operated for lesions of the lateral ligaments. The lesions observed, which were substantially symmetrical in the two sides of the talus, were: cartilage contusion: 20 cases; cartilage chapping: 13 cases; osteochondral fracture with no fragment displacement: 6 cases; osteochondral detachment with loosening of the detached fragment: 7 cases. The author emphasizes the problem of the frequency of lesions of the talus associated with capsulo-ligamentous lesions of the ankle joint (18% in his experience), and that of the site of osteochondral lesions on the lateral side of the trochlea. Finally, the author lists the reasons for which it is his belief that it is essential to know whether or not a capsulo-ligamentous lesion of the ankle joint is associated with osteocartilaginous lesions of the talus.

Adolescent↗
PubMed1989

[Partial or total enucleation of the talus. Value of conservative treatment. Apropos of 8 cases].

Eight cases of talus enucleations are reported. The patients ranged in age from 18 to 62 years. The follow-up period in this study extended from one year to 12 years. The talus was reduced in six cases and usually fixed with a trans-plantar pin. The main problem in the conservative treatment was represented by early infection which required a calcaneo-tibial arthrodesis. On the other hand, necrosis of the talus, although unavoidable, is usually well tolerated. That may be explained by the fact that the necrosis is dense and congruous and does not lead to severe arthritic changes. Among 5 cases of necrosis of the talus, fusion of the ankle and of the sub-talar joint was indicated in only one patient. The authors conclude that the conservative treatment should be systematically tempted and that arthrodesis should be indicated only for the infections, that usually appear early or the osteoarthritic changes which appear later.

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↗
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↗
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↗
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↗