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Wang R, You G, Yin S, Jiang S, Wang H, Shi H, Zhang L. Three-dimensional Mapping Analysis of Talus Fractures and Demonstration of Different Surgical Approaches for Talus Fractures. Orthop Surg 2024; 16:1196-1206. [PMID: 38485459 PMCID: PMC11062851 DOI: 10.1111/os.14033] [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: 10/29/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures. METHODS We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure. RESULTS Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches. CONCLUSION Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.
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Affiliation(s)
- Ruihan Wang
- School of Physical Education, Southwest Medical UniversityLuzhouChina
- Department of RehabilitationYibin Integrated Traditional Chinese and Western Medicine HospitalYibinChina
| | - Guixuan You
- School of Physical Education, Southwest Medical UniversityLuzhouChina
| | - Shiqin Yin
- School of Physical Education, Southwest Medical UniversityLuzhouChina
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical UniversityLuzhouChina
| | - Hai Wang
- Department of Medical ImagingYibin Integrated Traditional Chinese and Western Medicine HospitalYibinChina
| | - Houyin Shi
- Department of OrthopaedicsThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Center for Orthopaedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Luzhou Key Laboratory of Orthopedic DisordersLuzhouChina
| | - Lei Zhang
- Department of OrthopaedicsThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Center for Orthopaedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Luzhou Key Laboratory of Orthopedic DisordersLuzhouChina
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Talus Fractures: An Update on Current Concepts in Surgical Management. J Am Acad Orthop Surg 2022; 30:e1015-e1024. [PMID: 35862213 DOI: 10.5435/jaaos-d-20-01348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Talus fractures can be challenging injuries to treat because of complex talar shape, an abundance of articular cartilage, a potentially unforgiving soft-tissue envelope, and an easily injured blood supply. In addition, the spectra of energy involved, soft-tissue injury, and the fracture pattern are wide. Temporizing treatment is sometimes required, including débridement of open fractures, reduction of dislocations, and occasionally spanning external fixation. Definitive treatment first requires an understanding of the fracture pattern, including location and fracture line orientation. Multiple options for surgical exposure exist and are selected based on the fracture pattern and condition of the soft tissues. Newer fixation techniques, including the use of fixed-angle and minifragment implants, are useful in achieving stable fixation.
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Levitt EB, Patch DA, Johnson MD, McLynn R, Debell H, Harris JB, Spitler CA. What Are the Risk Factors for Infection After Operative Treatment of Peritalar Fracture Dislocations? J Orthop Trauma 2022; 36:251-256. [PMID: 34581699 DOI: 10.1097/bot.0000000000002274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the risk factors associated with deep infection after operative treatment of peritalar fracture dislocations. DESIGN A retrospective study was performed to identify patients who had operative treatment of a peritalar fracture dislocation over an 11-year period (2008-2019). SETTING Level 1 trauma center. PARTICIPANTS Patients were identified by review of all surgical billing that included open reduction of peritalar dislocation. Minimum follow-up for inclusion was 3 months or the outcome of interest. A total of 178 patients were identified, and 154 patients met inclusion criteria. MAIN OUTCOME The primary outcome was deep infection, defined as return to the operating room for debridement with positive cultures. RESULTS A total of 19 (12.3%) patients developed a postoperative deep infection. The most common associated fractures were talus (47%), calcaneus (33%), and fibula (9%) fractures. The infected group was significantly older (47.2 vs. 39.5 years, P = 0.03). Patients undergoing operative management for peritalar fracture dislocations with current smoking were found to have significantly higher odds of postoperative deep infection (74 vs. 34%, adjusted odds ratio = 7.4, 95% confidence interval, 2.3-24.1, P = 0.001). There was a significantly higher risk of infection in patients with a Gustilo-Anderson type 3 open fracture (32 vs. 12%, adjusted odds ratio = 5.7, 95% confidence interval, 1.6-20.3, P = 0.007). The infected group had high rates of below knee amputation when compared with the group without infection (47 vs. 1%, P < 0.001). CONCLUSION In our retrospective study, risk factors for infection after peritalar fracture dislocation included older age, smoking, and Gustilo-Anderson type 3 open fracture. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eli B Levitt
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Michael D Johnson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Ryan McLynn
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Henry Debell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - James B Harris
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL; and
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Abstract
OBJECTIVES To evaluate functional outcome after lateral process talus fracture using patient-reported instruments and identify injury characteristics that portend a worse prognosis. DESIGN Retrospective case series. SETTING Level 1 academic trauma center. PATIENTS/PARTICIPANTS Fifty-three patients with isolated lateral process talus fracture and 12 months of minimum follow-up. MAIN OUTCOME MEASUREMENTS Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and Foot and Ankle Ability Measure (FAAM). RESULTS Mean patient age was 33 years (range, 17-62 years), and mean follow-up was 6.5 years (range, 1-12 years). Twenty-one patients were initially treated nonoperatively and 14 of these patients (67%) failed nonoperative management. Patients who failed nonoperative treatment more commonly had a displaced fracture (12 patients) (P = 0.009). Thirty-two patients had displaced fracture and were treated with early operative fixation. For the entire cohort, final PROMIS PF was 55 (SD -8.3), FAAM Activities of Daily Living (ADL) was 89 (SD -14), and FAAM sport was 77 (SD -20). The patients treated with operative fixation had significantly larger fracture fragments (2050 vs. 1066 mm3, P = 0.017). There was no difference in final outcome between operative and nonoperative patients for PROMIS PF (P = 0.84), FAAM ADL (P = 0.95), or FAAM sport (P = 0.94). There were significantly more subtalar fusions in the nonoperative group (4 patients) as compared to the operative group (one patient) (P = 0.05). CONCLUSIONS Most patients with lateral process talus fracture achieve excellent outcome as measured by the PROMIS PF and FAAM at medium-term follow-up. Displaced fractures are likely best managed with early surgical treatment. Patients treated with early surgery have significantly fewer subtalar fusions as compared to patients with nonoperative treatment. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Zheng Y, Zhang JD, Shen JJ, Li XS, Huang JF. Surgical Outcomes of Articular Surface Crush Injury of Hawkins Ⅲ Talus Neck and Medial Malleolus Fracture. J Foot Ankle Surg 2021; 60:912-916. [PMID: 33836970 DOI: 10.1053/j.jfas.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/06/2020] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
The present study was performed to evaluate the effects of the medial and anterolateral approach combined with internal fixation by double head compression screws and countersunk K-wires for Hawkins Ⅲ talus neck and medial malleolus fracture. Eleven patients with articular surface crush injury resulting in Hawkins Ⅲ talus neck fractures accompanied by medial malleolus fractures were reviewed. All patients underwent emergency operations. The fractures were fixed using double head compression screws and countersunk K-wires through combined medial and anterolateral approaches. FAOS, AOFAS ankle-hindfoot scale, and VAS questionnaire scores were recorded. In addition, ROM of the ankle and postoperative complications were assessed. All patients were followed up for a median of 52.45 ± 5.15 months. The multiple scales data of FAOS on the affected side were: pain score 89.14 ± 7.08; activities of daily living score 89.57 ± 8.88; quality-of-life score 89.20 ± 7.44; sports score 75.00 ± 15.49; and other symptoms score 84.74 ± 7.51. The mean overall AOFAS ankle-hindfoot score was 88.36 ± 6.39. The VAS score was 0.72 ± 0.65. Ankle motion included dorsiflexion (13.18° ± 9.02°) and plantar flexion (32.27° ± 12.34°). Subtalar joint motion included eversion (10.91° ± 7.01°) and inversion (11.36° ± 7.45°). All scores of the healthy side were higher than those of the affected side (p < .05). In addition to ROM of the ankle and subtalar joint and sports score, various indicators of recovery rate had scores > 80%. One patient developed skin necrosis, which healed after debridement and wound dressing. Late complications included subtalar and/or ankle traumatic arthritis in six patients, four of whom showed no obvious clinical symptoms. In conclusion, the method of emergency surgery and medial and anterolateral approach combined with countersunk K-wires to fix small bone fragments to restore the integrity of the articular surface is acceptable for Hawkins Ⅲ talus neck with medial malleolus fracture.
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Affiliation(s)
- Yang Zheng
- Attending Doctor, Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiu-Dan Zhang
- Attending Doctor, Department of Endocrinology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jian-Jian Shen
- Attending Doctor, Department of Orthopaedics, The Affiliated Cixi Hospital of Wenzhou Medical University, Cixi, China
| | - Xu-Song Li
- Chief Physician, Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, Guangdong, China
| | - Jie-Feng Huang
- Associate Professor, Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Mao H, Wang H, Zhao J, Wang L, Yao L, Wei K. Initial assessment of treatment of talar posterior process fractures with open reduction and percutaneous fixation. Sci Rep 2020; 10:20221. [PMID: 33214632 PMCID: PMC7678821 DOI: 10.1038/s41598-020-77151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.
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Affiliation(s)
- Haijiao Mao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China.
| | - Haiqing Wang
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
| | - Jiyuan Zhao
- The Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Linger Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China
| | - Liwei Yao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China
| | - Ke Wei
- Department of Orthopaedic Surgery, Ningbo No. 9 Hospital, Ningbo, Zhejiang, China
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Technique for Open Reduction and Internal Fixation of Lateral Process Talus Fractures. J Orthop Trauma 2020; 34 Suppl 1:S9-S13. [PMID: 31939774 DOI: 10.1097/bot.0000000000001696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Lateral process fractures of the talus may occur either in isolation or in combination with a talar neck or body fracture. Screw fixation has been well described as a means of stabilization; however, many patients have multifragmentary fragments, unable to be controlled by isolated screw fixation alone. Plate fixation of the lateral process has been yet to be described in detail with presence of a clinical series. Here, we describe our technique of plate fixation for both isolated lateral process fractures and those that occur in conjunction with talar neck or body fracture.
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Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:701-719. [PMID: 31575401 DOI: 10.1016/j.mric.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
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