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Sharma S, Jindal K, Patel S, Prabhkar S, Prakash M, Rammelt S, Dhillon M. Parameters That Can Be Used to Quantify Reduction Accuracy in Talar Neck Fractures and Malunions: A PRISMA-Compliant Scoping Review and Meta-Analysis. Cureus 2024; 16:e58161. [PMID: 38741879 PMCID: PMC11089339 DOI: 10.7759/cureus.58161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Understanding the three-dimensional anatomy of the talar neck is essential in assessing the accuracy of reduction in talar neck fractures as well as for planning surgical correction for talar malunions. However, the geometrical parameters that describe this anatomy are sparsely reported in the orthopedics literature. We aimed to identify from the existing literature, geometrical parameters that describe the anatomy of the talar neck, determine how these are measured, and their normative values. A scoping literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. The primary searches were conducted on the PubMed, Embase, and Scopus databases. Any original research study looking at the human talus neck geometry was included. Parameters that described the anatomy of the talar neck were identified, and pooled estimates were determined by the random-effects meta-analysis model. Heterogeneity was assessed by the I2 test and leave-one-out meta-analysis. Subgroup analysis was done to compare the values of parameters between the Asian and Non-Asian populations. The risk of bias was assessed by the National Institutes of Health (NIH) Case Series Tool. The combined searches yielded 6326 results, of which 21 studies were included in the review and 15 in six different sets of metanalysis. The majority of the studies (n=19, 90.5%) evaluated adult tali, and only two (9.5%) evaluated pediatric tali. In most of the studies (n=13, 61.9%), talus neck geometry was evaluated on dry bones or anatomical specimens; evaluation by imaging techniques (radiographs, CT, MRI, and radiostereometric analysis) was used in eight studies, (39.1%). A total of eight different geometrical parameters (neck length, height, width, declination angle, inclination angle, torsion angle, circumference, and cross-sectional area) were identified. Except for talar torsion, variability was noted in methods of measurement of all other parameters. Subgroup analysis revealed that Asians had a higher neck height as compared to non-Asians; other parameters were not significantly different. Although the literature reports geometrical parameters to assess the talar geometry, the methods of measurement of these parameters are variable. Most of the available literature describes measurement techniques on cadaveric tali, and there is no literature on how these parameters should be measured on conventional CT or MRI slices. Further research needs to focus on the standardization of measurement techniques for these parameters on conventional CT and/or MRI scans.
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Affiliation(s)
- Siddhartha Sharma
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Karan Jindal
- Orthopedics, Dr. B. R. Ambedkar State Institute of Medical Sciences, Mohali, IND
| | - Sandeep Patel
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
| | - Sharad Prabhkar
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Mahesh Prakash
- Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, IND
| | - Stefan Rammelt
- Orthopedics, Accident, and Plastic Surgery, UniversitätsCentrum für Orthopädie, Unfall- und Plastische Chirurgie, University Hospital Carl Gustav Carus, Dresden, DEU
| | - Mandeep Dhillon
- Foot and Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IND
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Li Z, Xiao F, Huang H, Xia J, Zhou H, Li B, Yang Y. Impact of sustentaculum tali screw positioning on radiographic and functional outcomes in calcaneal fractures. J Orthop Surg Res 2024; 19:136. [PMID: 38347573 PMCID: PMC10863261 DOI: 10.1186/s13018-023-04521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND To investigate whether accurate placement of sustentaculum tali screws have the impacts on the clinical efficacy of calcaneal fractures. METHODS A retrospective analysis of 72 cases (73 feet) of calcaneal fractures from September 2015 to September 2019 treated with open reduction and internal fixation with sustentaculum tali screws was conducted. Patients were divided into the sustentaculum tali fixation group (ST group) and the sustentaculum fragment fixation group (STF group) according to the location of the sustentaculum tali screw placement. The functional outcomes at preoperative, 7 days and 1 year postoperative were collected and analyzed. RESULTS In the ST group (40 feet), the Gissane's angle altered from (109.89 ± 12.13)° to (121.23 ± 9.34)° and (119.08 ± 8.31)° at 7 days and 1 year postoperative, respectively. For Böhler's angles altered from (11.44 ± 5.94)°, to (31.39 ± 7.54)°, and (30.61 ± 7.94)° at 7 days and 1 year postoperative, respectively. In the STF group (33 feet), Gissane's angle altered from (110.47 ± 14.45)°, to (122.08 ± 8.84)°, and (120.67 ± 9.07)° and Böhler's angle altered from (11.32 ± 6.77)°, to (28.82 ± 8.52)°, and (28.25 ± 9.13)° (P < 0.001). However, there was no statistically significant difference in functional outcomes at 1 week after surgery and 1 year after surgery (P > 0.05). The AOFAS scores at the final follow-up of the two groups: ST group (88.95 ± 6.16) and STF group (89.78 ± 8.76); VAS scores, ST group (0.83 ± 0.98) and STF group (1.03 ± 1.59), all differences were not statistically significant (P > 0.05). CONCLUSION The position of sustentaculum tali screws has no significant difference on the short-term clinical outcome in patients with calcaneal fractures, while reliable fixation of screws to sustentaculum tali fragment can achieve similar clinical outcome. LEVEL OF EVIDENCE V
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Affiliation(s)
- Zihua Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Fajiao Xiao
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Hui Huang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Gundapaneni D, Tsatalis JT, Laughlin RT, Goswami T. Anthropomorphic Characterization of Ankle Joint. Bioengineering (Basel) 2023; 10:1212. [PMID: 37892942 PMCID: PMC10604250 DOI: 10.3390/bioengineering10101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Even though total ankle replacement has emerged as an alternative treatment to arthrodesis, the long-term clinical results are unsatisfactory. Proper design of the ankle device is required to achieve successful arthroplasty results. Therefore, a quantitative knowledge of the ankle joint is necessary. In this pilot study, imaging data of 22 subjects (with both females and males and across three age groups) was used to measure the morphological parameters of the ankle joint. A total of 40 measurements were collected by creating sections in the sagittal and coronal planes for the tibia and talus. Statistical analyses were performed to compare genders, age groups, and image acquisition techniques used to generate 3D models. About 13 measurements derived for parameters (TiAL, SRTi, TaAL, SRTa, TiW, TaW, and TTL) that are very critical for the implant design showed significant differences (p-value < 0.05) between males and females. Young adults showed a significant difference (p-value < 0.05) compared to adults for 15 measurements related to critical tibial and talus parameters (TiAL, TiW, TML, TaAL, SRTa, TaW, and TTL), but no significant differences were observed between young adults and older adults, and between adults and older adults for most of the parameters. A positive correlation (r > 0.70) was observed between tibial and talar width values and between the sagittal radius values. When compared with morphological parameters obtained in this study, the sizes of current total ankle replacement devices can only fit a very limited group of people in this study. This pilot study contributes to the comprehensive understanding of the effects of gender and age group on ankle joint morphology and the relationship between tibial and talus parameters that can be used to plan and design ankle devices.
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Affiliation(s)
- Dinesh Gundapaneni
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA;
| | - James T. Tsatalis
- Department of Radiology, Miami Valley Hospital, Dayton, OH 45409, USA;
| | - Richard T. Laughlin
- Department of Orthopedic Surgery, Sports Medicine and Rehabilitation, Miami Valley Hospital, Dayton, OH 45409, USA;
| | - Tarun Goswami
- Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH 45435, USA;
- Department of Orthopedic Surgery, Sports Medicine and Rehabilitation, Miami Valley Hospital, Dayton, OH 45409, USA;
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Liao LQ, Feng ZY, Li YK. Anatomical parameters of sustentaculum Tali screw placement in the Asian population: A retrospective radio-anatomical study. J Orthop Surg (Hong Kong) 2022; 30:10225536221082343. [PMID: 35388728 DOI: 10.1177/10225536221082343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: This study aimed to determine the anatomical parameters of successful Sustentaculum Tali (ST) screw placement in the Asian population. Method: CT scans of unilateral feet of 110 participants were reviewed, retrospectively. The 3 D reconstruction of the calcaneus and morphometric measurements were performed by Mimics Research 19.0 and 3-Matic Research 11.0. Finally, six cadaveric feet were used for verification of the accuracy of the measurements. Results: We discovered a method to help place ST screw successfully: (1) The entry point located at the middle section of the lateral wall of posterior talar articular surface (PTAS), and the perpendicular distance from the entry point to the lateral edge of PTAS (PDEL) was 10.78 mm, (2) Screw was perpendicular to the z-axis, 66.98° to the y-axis (the longitudinal axis of the foot), (3) The length of the ST screw should be approximately 44.74 mm in male and 41.14 mm in female, and (4) The diameter of the ST screw should be approximately 4.0 mm in male and 3.5 mm in female. With this new method, all screws in six cadaveric feet were placed successfully into the middle of ST. Conclusions: In this study, we discovered a general approach to safely place ST screws in the Asian population, which may potentially help surgeons improve their success rate in surgical practice.
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Affiliation(s)
- Li-Qing Liao
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Zi-Yu Feng
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
| | - Yi-Kai Li
- Department of TCM Orthopedics and Traumatology, School of Traditional Chinese Medicine, 70570Southern Medical University, Guangzhou, China
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Wang J, Qin S, Wang T, Liu J, Wang Z. Comparison of the Curative Effect of Percutaneous Reduction with Plastic Calcaneal Forceps Combined with Medial External Fixation in the Treatment of Intra-Articular Calcaneal Fractures. Orthop Surg 2021; 13:2344-2354. [PMID: 34767310 PMCID: PMC8654646 DOI: 10.1111/os.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the clinical efficacy of percutaneous minimally invasive reduction combined with external fixation and a tarsal sinus approach to treat Sanders type II and III intra‐articular calcaneal fractures. Methods The clinical data of 64 patients with Sanders type II and III calcaneal fractures admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed; data includedage, sex, body mass index. According to the surgical method, they were divided into the percutaneous minimally invasive reduction with internal and external fixation group (30 cases) and the tarsal sinus approach group (34 cases).The two groups of patients were compared in terms of the time tosurgery, length of hospital stay, intraoperative blood loss, operative duration, complications, radiographic features, including the heel bone length, width, height, Bohlerangle, Gissane angle, and calcaneal varus angle, and clinical efficacy indicators, including the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS) pain score, health survey profile (SF‐36) score and Maryland ankle function score. Results Patients in both groups were followed up for 12 to 50 months, with an average of 24.8 months.Bony union was achieved in all cases. The time to surgery, length of hospitalstay, intraoperative blood loss and incidence of incision‐related complications were significantly lower in the percutaneous minimally invasive medial external fixation group than in the tarsal sinus group (P < 0.01). At the last follow‐up, the calcaneal length, width, and height, Bohler angle, Gissane angle, and varus angle were significantly increased in both groups (P < 0.01), the calcaneal width was significantly lower after than before surgery (P < 0.01), and there were no statistically significant differences between the two groups (P > 0.05). As measures of clinical efficacy, the AOFAS, VAS, SF‐36 and Maryland scores were 85.28 ± 8.21, 0.84 ± 1.21, 82.95 ± 3.25 and 83.56 ± 3.32, respectively, at the last follow‐up in the percutaneous minimally invasive medial external fixation group and 83.32 ± 7.69, 1.85 ± 1.32, 80.71 ± 5.42, and 81.85 ± 2.41 in the tarsal sinus group, respectively, with no significant differences between the two groups (P > 0.05). Conclusion Under the condition of a good command of surgical indications and surgical skills, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with medial external fixation for the treatment of Sanders type II and III intra‐articular calcaneal fractures can achieve similar clinical effects as the tarsal sinus approach. However, the use of plastic calcaneal forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages, such as fewer complications, less bloodloss, and a shorter operation, and thus has good safety and is worthy of clinical promotion.
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Affiliation(s)
- Jianchuan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Song Qin
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Tienan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jibin Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zongpu Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Liu T, Jomha NM, Adeeb S, El-Rich M, Westover L. Investigation of the Average Shape and Principal Variations of the Human Talus Bone Using Statistic Shape Model. Front Bioeng Biotechnol 2020; 8:656. [PMID: 32714904 PMCID: PMC7351508 DOI: 10.3389/fbioe.2020.00656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the complexity of articular interconnections and tenuous blood supply to the talus, talus fractures are often associated with complications (e.g., avascular necrosis). Currently, surgically fusing the talus to adjacent bones is widely used as treatment to talus fractures, but this procedure can greatly reduce mobility in the ankle and hindfoot. Alternatively, customized talus implants have shown an overall satisfactory patient feedback but with the limitation of high expenses and time-consuming manufacturing process. In order to circumvent these disadvantages, universal talus implants have been proposed as a potential solution. In our study, we aimed to develop a methodology using Statistical Shape Model (SSM) to simulate the talus, and then evaluate the feasibility of the model to obtain the mean shape needed for universal implant design. In order to achieve this, we registered 98 tali (41 females and 57 males) and used the registered dataset to train our SSM. We used the mean shape derived from the SSM as the basis for our talus implant template, and compared our template with that of previous works. We found that our SSM mean shape talus implant was geometrically similar to implants from other works, which used a different method for the mean shape. This suggests the feasibility of SSM as a method of finding mean shape information for the development of universal implants. A second aim of our study was to investigate if one scalable talus implant can accommodate all patients. In our study, we focused on addressing this from a geometric perspective as there are multiple factors impacting this (e.g., articular surface contact characteristics, implant material properties). Our initial findings are that the first two principal components should be afforded consideration for the geometrical accuracy of talus implant design. Additional factors would need to be further evaluated for their role in informing universal talus implant design.
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Affiliation(s)
- Tao Liu
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada.,Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Nadr M Jomha
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, AB, Canada
| | - Marwan El-Rich
- Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
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Xu J, He Z, Zhang G, Chen Y, Wei C, Zheng Y, Lin H, Li W, Huang W. An experimental study on the digital precision of internal fixation via the sinus tarsi approach for calcaneal fractures. J Orthop Surg (Hong Kong) 2020; 27:2309499019834072. [PMID: 30866744 DOI: 10.1177/2309499019834072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness and accuracy of internal fixation of calcaneal fractures with a three-dimensional (3-D) printing navigation module via the sinus approach. METHODS Eleven lateral lower extremity specimens were used in the experiment and divided into the digital design (DD) group ( n = 11) and the real surgery (RS) group ( n = 11). For the DD group, thin-section computed tomography (CT) scans, virtual fracture modeling, virtual bone plate fixation, sinus occlusal module design, and navigation module design were performed for the cadaver specimens. A 3-D navigation module was printed using a 3-D printer. For the RS group, the sinus approach incision was made, and the navigation module was used to assist the placement of screw fixation and anatomically locked bone plate fixation. Thin-layer CT scans, 3-D reconstructions, and reconstruction of the nail paths were performed in the RS group and 3-D registered with the DD group. 3-D coordinate values for the screw entry and exit points in the RS and DD groups were recorded, and the corresponding offset values of the screw points were calculated. The number of qualified nails at different accuracy levels was counted. The χ2 test was used to compare the data for the DD and RS groups to obtain the accuracy level for both groups when p > 0.05, which is the critical value for experimental accuracy. RESULTS A total of 11 bone plates were placed and 120 screws were locked. None of them protruded from the inferior articular surface. The screw entry and exit point offsets were 1.71 ± 0.11 mm and 3.10 ± 0.19 mm, respectively. When the accuracy requirement for the entry point was 3.8 mm, there was no statistically significant difference between the two groups ( p > 0.05). Similarly, the accuracy of the exit point of the screw could only reach 6.6 mm. CONCLUSION Internal fixation of calcaneal fractures via the sinus tarsi approach with an anatomical locking plate based on the 3-D printing navigation module can achieve accurate screw placement and good overall internal fixation.
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Affiliation(s)
- Jing Xu
- 1 National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangdong Province, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Zaopeng He
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Guodong Zhang
- 3 Department of Orthopedics, Affiliated Hospital of Putian University, Licheng District, Putian City, China.,Jing Xu, Zaopeng He and Guodong Zhang contributed equally to this work, which Jing Xu is the first author, Zaopeng He and Guodong Zhang are the Co-first authors
| | - Yongshao Chen
- 4 Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Chunrong Wei
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Yudong Zheng
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Haibin Lin
- 3 Department of Orthopedics, Affiliated Hospital of Putian University, Licheng District, Putian City, China
| | - Wei Li
- 2 Hand and Foot Surgery & Plastic Surgery, Affiliated Shunde Hospital of Guangzhou Medical University, Shunde District, Foshan, China
| | - Wenhua Huang
- 1 National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangdong Province, China
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Agoada D, Kramer PA. Radiographic measurements of the talus and calcaneus in the adult pes planus foot type. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 171:613-627. [PMID: 31930491 DOI: 10.1002/ajpa.23994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A distinctive feature of the modern human foot is the presence of a medial longitudinal arch when weight-bearing. Although the talus and calcaneus play a major role in the structure and function of the human foot, the association between the morphology of these bones and longitudinal arch height has not been fully investigated. A better understanding of this relationship may assist in the interpretation of pedal remains of fossil hominins, where features of the foot and ankle morphology have been described as providing evidence for the presence of a longitudinal arch. METHODS For this study, weight-bearing radiographs of 103 patients from an urban US Level 1 trauma center, taken as part of a clinical examination for medical evaluation, were selected. These radiographs were classified as to foot type by arch height as defined using the calcaneal inclination angle. From this group, 68 radiographs were suitable for linear and angular measurements of the talus and 74 of the calcaneus. The relationships between these measurements and arch height were explored using least squared linear regression analysis. RESULTS The results demonstrate that angular measurements of the calcaneus (particularly those that reflect the relationship of the talar articular facets to each other and the tilt of the calcaneocuboid joint to the longitudinal axis of the calcaneus) are predictive of arch height (r2 = .29-.44 p ≤ .001). All angular measurements of the talus and all examined linear measurements of both the talus and calcaneus were not predictive of arch height. DISCUSSION These results suggest that certain angular measurements of the calcaneus are associated with arch height in the modern human foot. While this information is useful in the interpretation of hominin pedal remains, the relationship of the morphology of these bones, as well as other bones of the foot, to arch height is complex, requiring further investigation.
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Affiliation(s)
- David Agoada
- Department of Anthropology, University of Washington, Seattle, Washington
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Trovato A, El-Rich M, Adeeb S, Dhillon S, Jomha N. Geometric analysis of the talus and development of a generic talar prosthetic. Foot Ankle Surg 2017; 23:89-94. [PMID: 28578800 DOI: 10.1016/j.fas.2016.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/05/2016] [Accepted: 12/06/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Trauma to the talus can result in fracture, avascular necrosis and structural collapse. Treatment has been limited to surgical fusion and total ankle arthroplasty. Total ankle arthroplasty may not be an appropriate treatment for avascular necrosis while surgical fusion of the joint limits mobility. Custom-made implants have recently been used to address these limitations but have lengthy delays between injury and surgery and higher associated costs. A generic talar prosthesis available in various sizes may serve as a suitable alternative. METHODS The geometric variation between shapes of individual tali was determined using 3D geometric models of 91 tali created from CT-scan data. Comparisons were done to determine if tali are one shape. The best shape was determined for each sex, and was compared to determine if a unisex implant would be possible. A geometric template for the implant in multiple sizes was created and compared to the models. RESULTS The average of the average deviation between tali after volume scaling was found to be less than 1mm on the main articulating surfaces. One shape group was found for the talus. The female and male tali were found to be similar and a unisex implant template was created. CONCLUSIONS Ten generic talar implant sizes were determined to be sufficient to match the size and shape of the 91 tali examined in this study.
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Affiliation(s)
- Alexandra Trovato
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada.
| | - Marwan El-Rich
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada; Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta, Canada.
| | - Suki Dhillon
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
| | - Nadr Jomha
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Tümer N, Blankevoort L, van de Giessen M, Terra MP, de Jong PA, Weinans H, Tuijthof GJM, Zadpoor AA. Bone shape difference between control and osteochondral defect groups of the ankle joint. Osteoarthritis Cartilage 2016; 24:2108-2115. [PMID: 27495945 DOI: 10.1016/j.joca.2016.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/06/2016] [Accepted: 07/27/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The etiology of osteochondral defects (OCDs), for which the ankle (talocrural) joint is one of the common sites, is not yet fully understood. In this study, we hypothesized that bone shape plays a role in development of OCDs. Therefore, we quantitatively compared the morphology of the talus and the distal tibia between an OCD group and a control group. METHODS The shape variations of the talus and distal tibia were described separately by constructing two statistical shape models (SSMs) based on the segmentation of the bones from ankle computed tomography (CT) scans obtained from control (i.e., 35 CT scans) and OCD (i.e., 37 CT scans) groups. The first five modes of shape variation for the SSM corresponding to each bone were statistically compared between control and OCD groups using an analysis of variance (ANOVA) corrected with the Bonferroni for multiple comparisons. RESULTS The first five modes of variation in the SSMs respectively represented 49% and 40% of the total variance of talus and tibia. Less than 5% of the variance per mode was described by the higher modes. Mode 5 of the talus (P = 0.004) primarily describing changes in the vertical neck angle and Mode 1 of the tibia (P < 0.0001) representing variations at the medial malleolus, showed statistically significant difference between the control and OCD groups. CONCLUSION Shape differences exist between control and OCD groups. This indicates that a geometry modulated biomechanical behavior of the talocrural joint may be a risk factor for OCD.
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Affiliation(s)
- N Tümer
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands.
| | - L Blankevoort
- Orthopaedic Research Center Amsterdam, Academic Medical Centre (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - M van de Giessen
- Division of Image Processing, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - M P Terra
- Department of Radiology, Academic Medical Centre (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - P A de Jong
- Department of Radiology, UMC Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - H Weinans
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands; Department of Orthopedics, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands; Department of Rheumatology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - G J M Tuijthof
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands; Orthopaedic Research Center Amsterdam, Academic Medical Centre (AMC), Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
| | - A A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft, 2628 CD, The Netherlands.
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Zhang T, Chen W, Su Y, Wang H, Zhang Y. Does axial view still play an important role in dealing with calcaneal fractures? BMC Surg 2015; 15:19. [PMID: 25887075 PMCID: PMC4359527 DOI: 10.1186/s12893-015-0004-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background The study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures. Methods 156 patients with suspected unilateral calcaneal fractures were enrolled in the study, axial and lateral view of the affected foot and single axial view of the unaffected foot were gained. 16 were excluded due to unsatisfying axial radiograph. The remain 140 patients were eventually included into the study. Two separate assessments were conducted on two occasions with a three weeks interval to diagnose fractures. Lateral views were assessed firstly, and lateral combined with axial views were assessed three weeks later. Each of the 140 sets was evaluated by one of 6 surgeons randomly. Sensitivity and specificity value were compared between the two assessments. A new value Z which can directly reflect the degree of bulge on the calcaneal lateral wall on the axial view were introduced into the study. Z value of the 140 unaffected feet were measured. Data of another group of 31 patients who confirmed their lateral hindfoot pain caused by widening of calcaneus was reviewed. Liner regression was employed to analyze the relationship between angle Z and the severity of lateral pain. Results According to the two assessments, without axial view, specificity value will be significantly lower in diagnosing calcaneal fractures (p = 0.024) and sensitivity value will be significantly lower in distinguishing intra-articular fractures (p < 0.001). The normal threshold of angle Z was estimated from 98.06° to 100.64° (p <0.001). Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001). Conclusions Axial view is useful in diagnosing a patient with suspected calcaneal fracture especially for distinguishing intra-articular fractures and selection for CT scan. With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure. Axial view can still play an irreplaceable role in assessing and evaluating calcaneal fractures, and can be employed as an essential reference during surgical procedure . Electronic supplementary material The online version of this article (doi:10.1186/s12893-015-0004-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China.,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Yanling Su
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China.,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, China
| | - Haili Wang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China. .,Key Laboratory of Orthopaedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P.R. China. .,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, 050051, China.
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12
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Daud R, Abdul Kadir MR, Izman S, Md Saad AP, Lee MH, Che Ahmad A. Three-dimensional morphometric study of the trapezium shape of the trochlea tali. J Foot Ankle Surg 2013; 52:426-31. [PMID: 23623302 DOI: 10.1053/j.jfas.2013.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Indexed: 02/03/2023]
Abstract
The trapezium shape of the talar dome limits the use of 2-dimensional plain radiography for morphometric assessment because only 2 of the 4 required parameters can be measured. We used computed tomography data to measure the 4 morphologic parameters of the trochlea tali: anterior width, posterior width, trochlea tali length, and angle of trapezium shape. A total of 99 subjects underwent computed tomography scanning, and the left and right talus bones were both virtually modeled in 3 dimensions. The 4 morphologic parameters were measured 3 times each to obtain the intraclass correlation, and analysis of variance was used to check for any significant differences between the repeated measurements. The average intraclass correlation coefficient for the measurements for 2 to 3 trials was 0.94 ± 0.04. Statistical analyses were performed on the data from all 198 talus bones using SAS software, comparing male and female and left and right bones. All 4 morphometric values were greater in the male group. No significant differences were found between the left and right talus bones. A strong positive correlation was observed between the trochlea tali length and the anterior width. The angle of trapezium shape showed no correlation with the other 3 parameters. The measurements were compared with the dimensions of the current talar components of 4 total ankle arthroplasty implants. However, most of them did not perfectly match the trapezium shape of the talus from our population. We successfully analyzed the trapezium shape of the trochlea tali using reliable virtual 3-dimensional measurements. Compared with other published reports, our study showed a relatively smaller dimension of the trochlea tali than the European counterparts.
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Affiliation(s)
- Rosdi Daud
- Faculty of Mechanical Engineering, Universiti Malaysia Pahang, Pekan, Pahang, Malaysia
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Mahato NK, Murthy SSN. Metric analysis of loading magnitudes at articular and non-articular weight-bearing surfaces in human calcaneus. Foot (Edinb) 2013; 23:2-5. [PMID: 23158929 DOI: 10.1016/j.foot.2012.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/17/2012] [Accepted: 09/20/2012] [Indexed: 02/04/2023]
Abstract
The calcaneus is axially loaded at its articular interface with the talus. A large bulk of this load is transmitted to the ground across the non-articular tubercles at the plantar surface of the bone. A small part of the incumbent load sustained by the calcaneus is directed towards the forefoot at the calcaneo-cuboid junction. This study investigates the proportion of load distributed across the articular and non-articular surfaces of the calcaneus. The present study demonstrates strong and significant correlation between some of the load bearing variables and suggests the need for further investigations to understand the effect of angular aspects of axial loading on the calcaneus. Accounting for the relative distribution of weight across the articular and non-articular areas may enable us to appreciate the internal trabecular structure of the calcaneus in light of its clinical importance.
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Affiliation(s)
- Niladri Kumar Mahato
- Department of Anatomy, SRM Medical College & Research Centre, Kattankulathur, Kancheepuram District, Tamil Nadu, India.
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