A talar body fracture combined with bimalleolar ankle fracture

Ankle fractures combined with a talar body fracture imply either the medial or the lateral malleolus. The only report of a talar fracture combined with a bimalleolar ankle fracture found in the literature is referred to a talar neck fracture. We report a case of a simultaneous talar body fracture and bimalleolar ankle fracture in a young patient. This combined injury pattern appears to be very rare; one similar case was reported in the literature. An open reduction and internal fixation of the talar body fracture as well as the bimalleolar fracture, followed by a prolonged non-weight bearing, led to a fracture healing with no evidence of osteonecrosis. At the last follow-up, the functional result was satisfactory.     

Closed total talar extrusion after ankle sprain

Closed total talus dislocation from tibiotalar, subtalar, and talonavicular joints is a very rare injury. A 25-year-old young man, who had severe ankle distortion while walking down a flight of stairs, was brought to the emergency room complaining of a deformity and pain in his ankle joint. Roentgenographies revealed total talar body extrusion. The patient was treated urgently with open reduction in the authors' clinic. Tibialis posterior tendon might prevent closed reduction so open reduction with retraction of the tendon may be necessary.     

空心螺钉内固定治疗外踝陈旧性骨折并距骨脱位

2001年2月～2004年10月，我院共收治13例外踝陈旧性骨折合并距骨脱位患者，于外踝截骨距骨内移后行空心螺钉内固定外踝，对其中5例合并下胫腓联合分离采用拉力螺钉三层皮质固定，取得良好效果。     

Revisiting the concept of talar shift in ankle fractures

BACKGROUND: In 1976, Ramsey and Hamilton published a classic experiment investigating the biomechanical effects of talar shift in a simple ankle fracture model. Their finding was that 1 mm of talar shift resulted in a 42% decrease in tibiotalar contact surface area. Based on this conclusion, 1 mm of talar shift became the recognized indication for operative fixation. METHODS: Twelve cadaver ankles were dissected and the distal tibia coated with carbon powder. A 70-kg load was applied to the distal tibia that resulted in transference of the carbon onto the talus. The contact surface area was determined at 0, 1, 2, 4 and 6 mm of talar shift using spacers fixed in the medial gutter. Tracing paper was used to mark the outline of the contact area and measured using graph paper. RESULTS: Our results were similar to Ramsey and Hamilton's original experiment. One millimeter of lateral talar shift resulted in 40% loss of contact surface area compared with 42% in the original experiment. A large variance was seen in talar contact surface area depending on the morphology of the ankle joint. CONCLUSION: Ramsey and Hamilton's original experiment was valid.     

Tuberculosis arthritis of the ankle mimicking a talar osteochondritis

Tuberculosis arthritis of the ankle accounts for 10% of all cases of osteoarticular tuberculosis (OT). Because of its rarity and insidious symptoms, diagnosing it may be challenging. Furthermore, its imaging findings mimic those of other diseases.The case of ankle tuberculosis arthritis misdiagnosed as talus necrosis is reported. The difficulties faced by clinicians when confronting such situations are also illustrated.     

Total ankle replacement in ankle arthritis with varus talar deformity: pathophysiology, evaluation, and management principles

Varus malalignment of the ankle may be a misleading term. The isolated frontal plane deformity has been shown to be multiplanar in nature. Identifying this dominant feature of the condition and applying appropriate surgical principles to allow for complete correction of the deformity are critical to a successful outcome. The following 3 factors are key to an optimal surgical outcome from TAR with VMAA: (1) Obtaining a congruent ankle with sufficient ROM is a important before implantation of the arthroplasty prosthesis; (2) not all ankles are correctable; and (3) recognition both preoperatively and intraoperatively that a conversion of TAR to a fusion is sometimes the best course of action to achieve best results or patient satisfaction.     

Anterolateral talar palpation: A complementary test for ankle instability

Background

The anterior drawer test is traditionally used to assess ankle instability, but we believe that there is room for a small but effective improvement by adding digital palpation of the talus. We aimed to determine the accuracy of anterolateral talar palpation (ATP) in the diagnosis of ankle instability by comparing it with the traditional anterior drawer test.

Significance of talar distortion for ankle mobility in idiopathic clubfoot

The abnormal bony feature found most consistently in clubfeet is talar distortion. The significance of the talar distortion for mobility of the tibiotalar joint was investigated. Twenty-seven congenital clubfeet in 19 patients were examined at a minimal followup of 20 years. In all patients Turco's posteromedial release was done because of idiopathic clubfoot. Radiographic assessment of the feet included measurement of the talocalcaneal angle and index, and the tibiocalcaneal angle. The degree of talar flattening was estimated by the ratio of the curvature of the talar dome to the length of the talar bone (radius to length ratio). Three-dimensional gait analysis was done to assess the dynamic range of ankle motion. The static range of motion was measured with a goniometer. The degree of talar flattening correlated significantly with the dynamic range of ankle motion but not with the static mobility. For assessment of idiopathic clubfoot, evaluation of talar flattening should be done because of its significance for dynamic ankle mobility.     

Anterior placement of the talar component in total ankle arthroplasty: A risk factor for talar component subsidence

BackgroundComponent subsidence is considered as a cause of revision surgery. The talar component subsidence may be a risk factor for revision surgery; however, there are no reports regarding talar component placement and subsidence amount following total ankle arthroplasty (TAA). We therefore investigated the relationship between talar component placement and subsidence amount.MethodsFifty-two ankles from 49 patients (age: 71 years [range 62–83], 13 male/ 36 female), who underwent TAA with mean follow-up of 36 months (range 12–83), were included. The subjects were divided into two groups based on talar component placement: anterior placement (n = 20, group A) and posterior placement (n = 32, group P) using weight-bearing lateral plain radiographs. The amount of the talar component subsidence and clinical outcomes, which included the Japanese Society for Surgery of the Foot (JSSF) scale, range of the motion (ROM) and the revision rate, were compared between the groups.ResultsTalar component subsidence was significantly higher in group A (2.1 ± 2.0 mm) than in group P (0.6 ± 1.4 mm, P = .017). There was no significant difference in the JSSF scale and ROM between group A and group P. The revision rate was 10.0% in group A and 6.3% in group P, albeit not statistically significant.ConclusionGreater talar component subsidence was observed when the talar component was placed more anteriorly, suggesting that anterior placement of the talar component may need to be avoided during the surgery in order to minimize the postoperative talar component subsidence.     

Tibial and talar trabecular lines in the assessment of ankle alignment

The measurement of talar alignment in patients with ankle destruction due to arthritis or previous surgery can be difficult when planning surgery. Radiographs were used to determine whether tibial and talar trabecular lianes are a reliable method of assessment.Trabecular orientation within the talus and distal tibia was measured using an electronic goniometer in standard mortise view anteroposterior (AP) ankle radiographs from 25 normal patients. Radiographs of 12 cadaver ankles were taken in AP, and in 15 and 30° of both internal and external rotation and the trabecular orientation similarly measured. Three independent clinicians assessed the radiographs on two separate occasions.In the normal group the mean trabecular angle was 0.5° valgus (95 percentile: 4° varus to 5° valgus). In the cadaver group of mortise AP radiographs the mean trabecular angle was 1.6° valgus (95 percentile: 4° varus to 10° valgus). Positioning cadaver ankles in internal or external rotation had little effect on the mean trabecular angle, but observer variation increased.Normal ankles consistently have a tibio-talar trabecular angle of between 5° varus and 5° valgus on good mortise view AP radiographs. Uncertainty of measurement increased with rotation or plantarflexion of the ankle. These lines can be used to determine the varus/valgus orientation of the talus within the ankle joint, which may be useful when assessing joints destroyed by disease or removed at surgery.     

Chronic lateral instability of the ankle Roentgen stereophotogrammetry of talar position

Using roentgen stereophotogrammetric analysis (RSA), we investigated the talar mobility in 54 ankles during the anterior drawer and adduction tests. Talar tilt was increased in ankles with unilateral symptoms of chronic lateral instability. No other difference in talar tilt and anterior drawer sign was noted comparing ankles with and without symptoms.

We conclude that mechanical tests cannot always verify the diagnosis “chronic lateral instability of the ankle “.     

Incidence of chondral lesions of talar dome in ankle fracture types

BACKGROUND: Although the surgical treatment of ankle fractures is well known, a paucity of literature exists correlating chondral lesions with ankle fracture types. MATERIALS AND METHODS: This study is a retrospective review of patients with absence or presence of chondral lesions that underwent arthroscopically assisted open reduction and internal fixation between June 2002 and April 2005. There were 38 female and 48 male patients (mean age, 41.4 years; mean followup, 33.9 months), and all had an Ankle-Hindfoot Scale score. The relationship between fracture types and presence of lesions was evaluated. RESULTS: Four of 27 fractures with chondral lesions consisted of the bimalleolar type, 6 of 15 fractures with chondral lesions consisted of the trimalleolar type, and 14 of 20 distal fibula fractures had chondral lesions. There was significant greater incidence of chondral lesions associated with distal fibula fractures. The mean AOFAS score was 95.6 among all fractures. CONCLUSION: There is clear evidence that despite anatomic reduction, postoperative results of ankle fracture repair are not free of complications. We believe inspection of the talar dome should be routinely considered in the surgical repair ankle fractures.     

Incidence of lateral talar dome lesions in SER IV ankle fractures.

Osteochondral lesions of the talar dome are commonly the result of ankle trauma. While the technique of surgical repair of ankle fractures has been well reported, there are no studies that correlate the presence or absence of talar dome lesions. A possible explanation for this may be lack of intraoperative inspection of the talar articular surface. This retrospective study evaluates the incidence of lateral talar dome lesions in 50 supination-external rotation stage IV ankle fractures. Specifically, operative reports were reviewed for the presence of lateral talar dome lesions documented through intraoperative inspection. Overall, 19 of 50 fractures, or 38%, were found to have a lateral talar dome lesion. While the bimalleolar and deltoid ligament tear type fractures exhibited more talar dome lesions, there was no significant difference between these two fracture types (p = .1111). There was no statistically significant difference among the three types (unimalleolar, bimalleolar, and trimalleolar) of supination-external rotation ankle fractures (p = .0804). The authors conclude that intraoperative inspection of the lateral talar dome should be a routine part of ankle fracture repair.     

Chronic lateral instability of the ankle. Roentgen stereophotogrammetry of talar position

Using roentgen stereophotogrammetric analysis (RSA), we investigated the talar mobility in 54 ankles during the anterior drawer and adduction tests. Talar tilt was increased in ankles with unilateral symptoms of chronic lateral instability. No other difference in talar tilt and anterior drawer sign was noted comparing ankles with and without symptoms. We conclude that mechanical tests cannot always verify the diagnosis "chronic lateral instability of the ankle".