Talus bipartitus

Talus bipartitus is an exceptional congenital malformation consisting in the presence of two non-fused bony talar fragments. We report the case of an adolescent girl who complained of mechanical pain in the left ankle which became increasingly invalidating. Plain radiographs, CT-scan and MRI led to the diagnosis of this congenital anomaly: talus bipartitus. Surgical correction by subtalar arthrodesis provided improvement at the cost of reduced ankle mobility. Surgical treatment should be proposed for talus bipartitus in patients with invalidating pain or stiffness when rehabilitation fails to provide sufficient improvement.     

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.     

Osteochondral lesion of the talus in a recreational athlete: a case report

A 23-year-old recreational male athlete presented with intermittent pain of three weeks duration, localized to the left ankle. Pain was aggravated by walking, although his symptoms had not affected the patient’s jogging activity which was performed three times per week. Past history revealed an inversion sprain of the left ankle, sustained fifteen months previously. Examination showed mild swelling anterior to the ankle mortise joint while other tests including range of motion, strength and motion palpation of specific joints of the ankle were noted to be unremarkable. Radiographic findings revealed a defect in the medial aspect of the talus. An orthopaedic referral was made for further evaluation. Tomography revealed a Grade III osteochondral lesion of the talus.It was determined that follow-up views be taken in three months to demonstrate if the lesion was progressing or healing. Within the three month period, activity modifications and modalities for pain control were indicated. Surgery was considered a reasonable option should conservative measures fail.The present case illustrates an osteochondral lesion of the talus, a condition which has not previously been reported in the chiropractic literature. A review of the pertinent orthopaedic literature has indicated an average delay of three years in diagnosing the existence of this lesion.Although considered rare, the diagnostic frequency of the condition appears to be on the rise due to increased awareness and the use of bone and CT scans. The osteochondral lesion of the talus deserves particular consideration by practitioners working with athletes due to its higher incidence within this group. This diagnosis should be considered in patients presenting with chronic ankle pain particularly when a history of an inversion sprain exists.The purpose of this report is to increase awareness of this condition, and review diagnosis and management strategies.     

Accessory Anterolateral Talar Facet Syndrome After Treatment of Neglected Fracture of the Lateral Process of the Talus: A Case Report

Fracture of the lateral process of the talus has often been missed or confused with lateral ankle sprain, and this can lead to long-term untreated cases of nonunion, malunion, and subtalar joint osteoarthritis. In a review of the published data, accessory anterolateral talar facet syndrome was not found after treatment of nonunion of the lateral process of the talus fracture. This report presents the case of a 40-year-old male snowboard instructor who suffered from a neglected fracture of the lateral process of the talus and was treated with open reduction using an iliac autogenous bone graft. Subsequently, partial resection of the anterior aspect of the process was required to treat the impingement syndrome that developed secondary to the united but enlarged lateral process. The patient resumed his activities a year after the second operation. We describe the consequences of misdiagnosis of the lateral process of the talus and its management.     

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.     

The os trigonum syndrome: use of bone scan in the diagnosis

The os trigonum is an accessory bone of the foot found in 7% of the normal adult population. It is located at the posterolateral projection of the talus, and can occasionally give rise to symptoms of acute and chronic unexplained ankle pain. We report three patients, one with acute fracture and two with chronic ankle symptoms. Technetium 99 methylene diphosphonate showed intense focal uptake at the posterior talus pointing to the os trigonum as the site of symptoms. It was excised in two patients with complete relief. The third went on to develop an asymptomatic nonunion. We recommend bone scanning as a procedure that is helpful in delineating obscure pain in the ankle that may be due to chronic irritative nonunion of the os trigonum.     

Intra-osseous lipoma of the talus: a case report

Intra-osseous lipomas are rare benign tumours. We report one such case in the talus of a 60-year-old man. The patient underwent curettage and bone grafting. At the 22-month follow-up, radiographs of the talus showed dense sclerosis with multiple cortical breaks in the anterior process and no evidence of local recurrence or avascular necrosis. The patient had a painless ankle joint with normal range of movement.     

Dysplasia Epiphysealis Hemimelica of Talus Mimicking Posterior Ankle Impingement Syndrome in a Young Male: A Case Report with Review of the Literature

Dysplasia epiphysealis hemimelica is a rare skeletal developmental disorder representing an osteocartilaginous tumor arising from 1 or more epiphyses during childhood. We report a case of a young male who presented with complaints of pain and swelling in the posteromedial aspect of the left ankle with the clinical diagnosis of posterior impingement syndrome. Imaging studies, including radiography, computed tomography, and magnetic resonance imaging, suggested the possibility of localized juxta-articular dysplasia epiphysealis hemimelica arising from the talus. The patient was successfully treated by surgical excision. The postoperative histologic findings were consistent with osteochondroma. This case report emphasizes the possibility of dysplasia epiphysealis hemimelica in the differential diagnosis of impingement syndromes around the ankle. The aim of the present study was to familiarize clinicians with this rare entity, because the number of documented cases has been increasing.     

Subtalar dislocation without associated fractures: Case report and review of literature

Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed.     

Imaging of osteochondral lesions of the talus

A review of the literature reveals that all studies have been performed retrospectively. These studies have included limited numbers of low-grade lesions and no prospective, randomized, comparison studies have been performed to suggest the superiority of CT scanning over MR imaging. The following conclusions, however, can be made. Plain radiographs are useful in the initial evaluation of patients with acute or chronic complaints of ankle pain and swelling. These initial studies, however, may not identify all osteochondral lesions of the talus, particularly lower grade lesions. CT scanning can accurately identify and localize a lesion while defining its extent. It has been suggested that CT scanning can be used to assess whether bony healing has occurred at follow-up. MR imaging can also precisely identify, localize, and define an OLT with the advantage of assessing the integrity of the overlying cartilage. It can detect lower grade lesions with improved sensitivity and may aid in the differentiation of Stage II and Stage III lesions. Using the preceding observations, the following approach is recommended in the evaluation and work-up of an osteochondral lesion of the talus (Fig. 7). The patient who presents with ankle pain and swelling should have weight-bearing radiographs of the ankle obtained. If these films demonstrate an osteochondral lesion of the talus, staging of the lesion should be performed. In lesions that appear nondisplaced on plain radiography (low grade; stable), MR imaging is recommended so the clinician can evaluate the integrity of the overlying cartilage and assess the true stability of the lesion. In lesions that appear displaced on plain radiography (high grade; unstable), the CT scan is the preferred modality in order to provide accurate assessment of lesion size and location. It should be noted, however, that no study has prospectively [figure: see text] compared the efficacy of these two modalities in the evaluation of osteochondral lesions. If a symptomatic patient presents with negative plain films, then an initial period of immobilization using a cast or boot brace is recommended. This is followed by joint mobilization and range of motion exercises. If the patient remains symptomatic at the 4 to 6 week followup period, then an MR image should be performed. This study provides information regarding soft-tissue impingement, proliferative synovitis, and other bony and soft-tissue pathology. The authors have found that despite the results of bone scintigraphy, an MR image is invariably obtained. Because of this the authors do not recommend bone scintigraphy in the evaluation and diagnosis of OLT.     

Management of failed total ankle replacement with a retrograde short femoral nail: a case report

Arthrodesis of the ankle joint after failed total ankle replacement using internal fixation with plates and screws is problematic because of the significant bone loss. An external fixator has the disadvantage of prolonged treatment until complete consolidation, frequently complicated by pin track infections. Recently an intramedullary fixation has been described for tibio-talo-calcaneal arthrodesis for posttraumatic osteoarthritis of the ankle joint. We report on the use of this technique plus bone graft in a case of failed total ankle replacement complicated by cystic talus degeneration and a massive bony defect. The advantages include early mobilization and weightbearing provided by the stability of the fixation.     

Chondroblastoma of the talus: a case report and literature review

Chondroblastoma is a rare, benign cartilaginous neoplasm that accounts for approximately 1% of all bone tumors, and approximately 4% of all chondroblastomas arise in the talus. Here we report a case of chondroblastoma in the left talus. The 22-year-old male patient presented with a 16-month history of ankle pain. Based on radiological and pathological examination, we diagnosed the patient with chondroblastoma. A posterolateral approach was used to allow access to the lesion. After curettage, the allogenic bone chips were packed into the talar body defect. After 2 years' follow-up, we found no recurrence or metastasis of chondroblastoma, suggesting our surgery procedure was effective.     

Transient osteoporosis of the talus

We report the case of a 60-year-old male who presented to the orthopaedic clinic with transient osteoporosis of the talus. Clinical and radiological findings, particularly MRI, were consistent with previous reports of this rare and poorly-understood condition. Interestingly, this patient presents with two separate but similar episodes of ankle pain documented over a 6-year period, and the suggestion is made of recurrence of transient osteoporosis in the same bone, with the severity of the recurring episode being notably greater than the initial one. The Mazur foot and ankle scoring system was used to assess function throughout this period of follow-up. Both episodes resolved over time with conservative management only, i.e. rest, elevation and simple (non-NSAID) analgesia. Transient osteoporosis is otherwise known as bone marrow oedema syndrome, although controversy surrounds its nomenclature and aetiology as a distinctive self-limiting disease.     

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

Summary 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 [3]. 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.     

Reconstruction with vascularized medial femoral condyle flaps in hindfoot and ankle defects: A report of two cases

In this article, we report using free vascularized medial femoral condyle (MFC) flaps for reconstruction of bone defects and nonunion of the hindfoot and ankle in two patients. One patient had an open calcaneal fracture and hindfoot bone defect with impaired gait due to Achilles tendon functional loss. The second patient had nonunion with a chondral defect of the talus after a fall. Following uneventful recoveries, good objective and subjective results were achieved in terms of pain reduction and improved gait in both patients. No further operative intervention was needed during a 3‐year follow‐up period. The versatility of the corticoperiosteal graft from the MFC makes it an important reconstructive tool for addressing several major surgical problems of bony nonunion in the extremities, including posttraumatic reconstruction of hindfoot and ankle disorders. © 2014 Wiley Periodicals, Inc. Microsurgery 34:576–581, 2014.     

Fracture rare du corps du talus: à propos d’un cas et revue de littérature

Fracture of the talar body is rare; it reaches articular congruence and determines the ankle’s functional prognosis. We report the case of a fracture of the talar body with sagittal features associated with fracture of the medial malleolus in an 18-year-old patient; the mechanism of the fracture was plantar hyperflexion, internal rotation and axial compression. The patient was treated with open reduction and stabilization with two small screws for the talus and two others for the medial malleolus. The outcome after six months was good. A study of the mechanism is presented along with a literature review, therapeutic factors and prognosis.     

Osteochondral fractures of the dome of the talus.

Fractures of the talor dome are uncommon and may elude diagnosis despite routine roentgenograms of injured ankles. Tomograms are helpful in localizing this lesion. Surgical removal of the osteochondral fragment is often indicated. Medial lesions may be inaccessible except by osteotomy of the medial malleolus which is then fixed with a bone screw. Lateral fragments are approached through anterolateral or posterolateral ankle incisions. Of 9 symptomatic ankles, 6 had satisfactory results following surgery. The other 3 were treated conservatively, one improved; two did not. One additional asymptomatic ankle remained so with no treatment. In one case the talus also contained an unusual cystic lesion; in another there was tarsal coalition.     

Neglected lateral process of talus fracture presenting as a loose body in tarsal canal

Lateral process fractures of talus are rare injuries with a potential to cause significant morbidity if rnisdiagnosed.The appropriate management of these fractures is still controversial and only a few reports are available on this subject.We presented a case of a 37-year-old male with neglected fracture on the lateral process of talus which was misdiagnosed at the time of injury.The patient presented to 7 months after misdiagnosis with a chronic ankle pain.Our case is unique in the sense that it is a rare case of neglected fracture on the lateral process of talus which presented as a loose body in sinus tarsi.However,a surgery with an excision of the loose body presented a satisfactory outcome along with 2 years' follow-up.To our knowledge,it ought to be the first case reported in the English literature.Through this case report,we highlight the importance of high index of suspicion for such rare bony injuries while evaluating trauma to the lateral side of ankle and discuss the principles of management of these fractures.     

Atraumatic Bilateral Insufficiency Fractures of the Talar Neck in a Rheumatoid Patient

We report a 73-year-old female with rheumatoid arthritis, who presented with a 1-year history of ankle pain without trauma. Conventional radiographs showed no bony abnormalities, and bone scintigraphy showed increased uptake in the neck of the left and right talus. Magnetic resonance imaging scans showed insufficiency fractures of the talar neck bilaterally. The patient was treated nonoperatively with weightbearing casts and analgesics. The present case study stresses the need to add insufficiency fractures of the talus to the differential diagnosis of chronic ankle pain when conventional radiographs show no abnormalities.     

Traumatic loss of talus: A rare injury

BackgroundTraumatic loss of talus during a compound injury of ankle is an unusual injury.ObjectiveWe report a 55 years old woman who sustained an open ankle injury with complete extrusion of talus and loss at the injury site.MethodA tricortical bone graft was obtained from iliac crest and talar dimensions carved with 5 cm length and 3 cm height given by buttressing fibular graft between them. These grafts are made in the shape of talus by fixing them together with cortical screw and binding them together with Ethibond No. 5. By anterior approach ankle was opened and talar graft was placed in between the raw surfaces of tibia and calcaneus to facilitate ankle arthrodesis.ResultPatient had solid fusion at the ankle joint after 4 months with no pain on walking.ConclusionThe definitive treatment of this serious lower extremity injury remains controversial we have attempted this novel way of treatment as the patient was unable to afford talar prosthesis and facilities of allogenic bone grafts were not there.