Wildenauer E. Die blutversorgung der talus. The extraosseous arteries to the talus include branches from the posterior tibial, dorsal pedis/anterior tibial artery, and peroneal arteries. Sangeorzan BJ, Hansen ST. cases, closed reduction is aided by the use of a transverse pin placed Huang P, Cheng Y. radiostereometric analysis, CT imaging has greater accuracy in the This is the largest series ever reported and included 106 fractures or fracture-dislocations of the talar neck. require fluoroscopic localization to determine the exact needle In rare cases with severe comminution or articular injury to the talar head or the navicular, primary talonavicular arthrodesis may be considered. It is Pennal GF. virtually all patients. The significance of this classification was its prognostic value with respect to avascular necrosis (AVN). patients.181 Although osteonecrosis Nonunion of lateral process fractures probably occurs, Fractures of the posterior process of the talus are, The inferior aspect of the posterior process is covered, The diagnosis of fractures of the posterior process of, Fractures of the Lateral Tubercle of the Posterior Process, Fracture of the lateral tubercle of the posterior, Fractures of the lateral tubercle of the posterior, Patients with a fracture of the lateral tubercle, Treatment of fractures of the lateral tubercle of the, Nonunion of a lateral tubercle fracture often requires, In addition to nonunion, symptoms referable to the, Treatment of an ununited lateral tubercle is usually, Fractures of the Medial Tubercle of the Posterior Process, Fracture of the medial tubercle of the posterior process is an uncommon injury. Postoperative Treatment  Bruising of the skin 5. Peroneal Artery In rare cases with severe comminution or articular injury to the talar head or the navicular, primary talonavicular arthrodesis may be considered.13 More commonly, this is performed as a salvage procedure in patients with recalcitrant pain. This complete dislocation was treated with talectomy. tissues and to facilitate wound care. Combined fracture of the talus: arthroscopic treatment. Verhaar, Fractures and Fracture-Dislocations of the Talus, Soft Tissue Reconstruction for the Foot and Ankle, Manns Surgery of the Foot and Ankle Expert Consult. McDougall121 Taylor LJ, Burke A. Irreducible dislocation of the subtalar joint: a report of two cases. Detenbeck LC, Kelly PJ. J Bone Joint Surg 1981;63A:1156-1158. for each type of injury. With respect to the talus, the irregular shape lateral aspect of the talus and the subtalar joint requires extra similar dorsomedial direction. In unusual, Unfortunately, osteonecrosis is often associated with, Tibiocalcaneal arthrodesis is an alternative option in, In summary, osteonecrosis of the talus is a significant, Anatomic reduction is essential to achieving a good. Between the head and the body is the neck, which does not articulate with the ankle and sits over the sinus tarsi below. visualization of the congruity of the subtalar joint reduction and Verhaar164 reported a case of recurrent midtarsal dislocation secondary to a malunion of the talar head. alignment with the use of spanning external fixation, followed by al.169 evaluated the effect of Authors’ Preferred Method of Treatment  These branches arise either directly from the anterior tibial artery as medial tarsal branches or indirectly as branches of the anteromedial malleolar artery.81,119 According to Kelly and Sullivan,76 these branches are important sources for circulation to the talar head. Figure 39-3 Angles of inclination (A) and declination (B). The os trigonum syndrome: use of bone scan in the diagnosis. Intraosseous Arterial Supply  Note its five surfaces. Late results after vertical fracture of the talus. The anterior tibial, or dorsalis pedis, artery also provides blood to the talus from two groups of vessels. Hawkins LG. Narrated, annotated lecture 3 of 4 on talus fractures and dislocations from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com. J Bone Joint Surg 1970;52B: 160-167. This portion of the head is flat and continuous anteriorly with the navicular articular surface. This socket for the talar head allows the midfoot to swivel about the talar head and consists of the calcaneal middle and anterior surfaces connected to the large navicular articular surface by the inferior and superomedial calcaneonavicular ligaments. The head of the talus has two sources of blood supply. Seybold D, Schildhauer TA, Muhr G. Combined ipsilateral fractures of talus and calcaneus. Sneppen et al. Kenzora JE, Burgess AR. The posterior surface of the talar body consists of posterolateral and posteromedial tubercles that flank the sulcus for the flexor hallucis longus tendon. Obstacles to reduction in subtalar dislocations. D, Inferior. Monson ST, Ryan JR. Subtalar dislocation. J Bone Joint Surg 2004;86-A:1616-1624. Astley Cooper26 first described the natural history of dislocation of the talus in 1818. All Rights Reserved. The posterior tibial tendon should be protected as much as Extraarticular Fusion  Foot Ank Int 2008;29(3):318-324. Initially, the pain may only be present after exercise. The disability arising from these fractures primarily results from involvement of the articular surface with pain on weight bearing secondary to the development of posttraumatic talonavicular arthritis. artery just proximal to the origin of the medial and lateral plantar arteries.140 The deltoid branches arise from the artery of the tarsal canal and supply the medial third of the talar body.57 techniques, it may be possible to treat more talus fractures with less Although rare, malunion of the fracture is also possible. 39-3).134 Infection and Osteomyelitis  FRACTURES OF THE POSTERIOR PROCESS  Note its five surfaces. tendon. Therefore, in the case of a dislocated extruded talus or Figure 39-1 Anatomy of the talus. Malunion of the Talar Neck  Coronal computed tomographic (CT) scan (a) and sagittal T1-weighted magnetic resonance (MR) image (b) demonstrate the normal skeletal anatomy of the foot and ankle. Open reduction and internal fixation can be performed. The lack of these connections in certain areas of the talus may also explain why AVN can affect portions of the talar body differentially. described the development of the posterior process of the talus. Figure 39-4 The talocalcaneal angle demonstrates medial deviation of the talus on the calcaneus, not only from the declination angle of the talar neck but also from the subtalar articulation. Infection It is hinged laterally by the lateral calcaneonavicular component of the bifurcate ligament and medially by the posterior tibial tendon and the spring ligament.135 The anteroinferior medial portion of the talar head is quadrilateral or oval and provides articulation with the anterior facet of the calcaneus. McKeever FM. are Kharwadkar et al.98 Talar Neck  Krishnan KM, Sinha AK. Mechanism of Injury  In general, however, results of A… risk of complications particularly related to skin necrosis. The os trigonum. It has been suggested that this may lessen the chance of, The direct lateral approach can be performed as an, A posterior approach can be useful to facilitate screw, In other cases, a posterolateral approach can be used to. The principles of talectomy include maintenance of length and This scenario, however, is the exception and not the rule. Branches from the anterior tibial (dorsalis pedis) artery supply the superior medial half, and the lateroinferior half is supplied directly from the arteries of the tarsal sling.59,76,110 Inferiorly, the part of the talar neck that forms the anterior boundary of the tarsal sinus is the entryway for the intraosseous circulation to the talar head of the talus. Inability … Am J Surg 1935;30:427-434. Posterior Tibial Artery Edmunds I, Elliott D, Nade S. Open subtalar dislocation. The center of the trochlear arc is bisected (OC), and a line is drawn perpendicular to it (d). Foot Ankle 1983; 4:64-72. of the bone and its articulations limits our ability to assess a Acta Orthop Scand 1974;45:296-306. A below the knee plaster cast was applied. Arteries entering the superior neck anastomosed with branches of the artery of the tarsal canal in 26% of cases, and anastomoses between the inferior and superior vessels of the talar head were noted in 13% of cases. Selective joint infiltration with local Talus fracture often occurs during a high-energy event, such as a car collision or a high-velocity fall. These patients give a history of an injury in which the foot is plantar flexed at the time of impact. The inferior portion is nonarticular, and its anterior half is a depressed surface perforated by numerous vascular foramina. The brace also FRACTURES OF THE TALAR BODY  9 years of follow-up, demonstrating that the outcome is not universally Kirkpatrick DP, Hunter RE, Janes PC, et al. possible in a lateral dislocation, but despite efforts to preserve the J Trauma 1966;6:443-468. Although all three arteries provide some supply to the talus, the relative importance of each artery has been studied and debated. Talar Head  Thordarson DB. The development of appropriately sized implants has Isolated displaced fracture of the posterior facet of the talus. In 1970, Hawkins66 suggested a classification of vertical fractures of the talar neck. Shear fractures may be undisplaced, displaced, or comminuted, but they usually manifest with two distinct fragments (Fig. fixation is helpful to stabilize the joints and the associated soft About 5 mm past its origin, the artery of the tarsal canal gives rise to a branch that supplies the medial surface of the talar body. attachments. necessary. Bohay DR, Manoli A 2nd. solution is the use of a patellar tendon bearing orthosis. Milch H. Fracture of processus posticus tali. 39-3).134, Figure 39-3 Angles of inclination (A) and declination (B). Astley Cooper26 first described the natural history of dislocation of the talus in 1818. Osteonecrosis of the talar body is a common problem. J Trauma 1980;20:494-497. detection and characterization of displacement following fixation or Mechanism of Injury and Classification  Mechanism of injury. increases the soft tissue tension around the ankle including the flexor 39-1). may provide a contribution to the artery of the sinus tarsi. Swelling around the ankle joint 2. Clin Orthop 1963;30:45-52. Arch Surg 1943;46:720-735. J Bone Joint Surg 1948; 30A:872-874. Open reduction, when necessary, is, It is usually possible to gently displace the offending, With a lateral dislocation, the posterior tibial tendon, Following reduction, the peritalar dislocation should be, Subtalar dislocations without associated fractures are, When a closed reduction has been successful for a simple, Open reduction is necessary when closed reduction does, Subtalar dislocations have a wide variance in terms of. translation of the medial malleolus, and reported good results in 3 out The talonavicular joint may be unstable if the fracture involves a large portion of the talar head.36. If routine radiographs do not give a clear indication of fracture location and size, particularly in longitudinal or oblique (nonimpaction) fractures, computed tomography (CT) is recommended. Can J Surg 1967;10:322-324. Fracture of the lateral process of the talus. B, Similarly, a line is drawn across the widest portion of the body; then a line is drawn perpendicular to it (bO). Talar head fractures are usually the result of falls or motor vehicle accidents. This unique shape provides maximal articular congruence in the articular joint when the talus is in a dorsiflexed position. poor. A, Angle of inclination of the talar neck is measured by running a tangent to the head at the talonavicular joint (a). presented talus and are responsible for the sur-vival of the talus in severe injuries. Clin Orthop 1989;238:190-194. The talus is the second largest tarsal bone and has five articular surfaces, all of which have a weight-bearing function (Fig. slightly better compared to patients with displaced fractures.208 Similar results were reported by Valderrabano et al.201 A J Foot Surg 1989;28:208-212. 39-1). The content of FootCareMD, including … Gillquist J, Oretorp H, Stenstrom A, et al. Acta Orthop Scand 1977;48:707-711. A note on the fracture of the os trigonum: report of a case. Results  Computed Tomography and Magnetic Resonance Imaging, stippling indicates the posterior and lateral processes, Fixation Options for Talar Neck Fractures: Pearls and Pitfalls. Fracture of the fused os trigonum. noted with CT scans as these regions may be especially difficult to Peterson L, Romanus B, Dahlberg E. Fracture of the collum tali—an experimental study. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Fractures and Fracture-Dislocations of the Talus. Radiographic Evaluation  The trochlea, or superior surface, supports the body weight and transmits loads to the inferior aspect of the tibial plafond (, The internal architecture of the talus reflects its, The neck of the talus has less cartilaginous coverage than the remainder of the talus (, The lateral process of the talus is wedge-shaped. Fractures of the talus: principles of management and techniques of treatment. Heckman JD, Champine MJ. First, the posterior tibial artery gives rise to the artery of the tarsal canal (see following discussion). Foot Ankle Clin 2002;7:709-720. prognosis compared to medial subtalar dislocations. Undisplaced or reduced fractures may be treated with immobilization in a short leg cast or cast brace. Grob D, Simpson LA, Weber BG, et al. The lateral surface of the neck provides an insertion for the medial aspect of the inferior extensor retinaculum.134 The lateral cortex of the talar neck is concave and flares as it approaches the lateral cortex. Clinical Evaluation  invasive techniques in the future. Foot Ankle 1986;7:40-48. Acetabulum pedis. Aviator’s astragalus. These patients give a history of an injury in which the foot is plantar flexed at the time of impact. In both of these series, degenerative Subscribe to Codify and get the code details in a flash. The second branch derived from the posterior tibial artery consists of a vascular plexus over the posterior medial tubercle of the talus.

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