PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (431207)

Clipboard (0)
None

Related Articles

1.  Talocrural Dislocation With Associated Weber Type C Fibular Fracture in a Collegiate Football Player: A Case Report 
Journal of Athletic Training  2008;43(3):319-325.
Objective:
To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete.
Background:
The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex.
Differential Diagnosis:
Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption.
Treatment:
The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible.
Uniqueness:
Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete.
Conclusions:
Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient.
PMCID: PMC2386426  PMID: 18523569
ankle dislocations; fibular fractures; syndesmosis injuries; athletic injuries
2.  A new approach to the treatment of congenital vertical talus 
Congenital vertical talus is an uncommon foot deformity that is present at birth and results in a rigid flatfoot deformity. Left untreated the deformity can result in pain and disability. Though the exact etiology of vertical talus is unknown, an increasing number of cases have been shown to have a genetic cause. Approximately 50% of all cases of vertical talus are associated with other neuromuscular abnormalities or known genetic syndromes. The remaining 50% of cases were once thought to be idiopathic in nature. However, there is increasing evidence that many of these cases are related to single gene defects. Most patients with vertical talus have been treated with major reconstructive surgeries that are fraught with complications such as wound necrosis, talar necrosis, undercorrection of the deformity, stiffness of the ankle and subtalar joint, and the eventual need for multiple operative procedures. Recently, a new approach to vertical talus that consists of serial casting and minimal surgery has resulted in excellent correction in the short-term. Longer follow-up will be necessary to ensure maintenance of correction with this new technique. A less invasive approach to the correction of vertical talus may provide more favorable long-term outcomes than more extensive surgery as has been shown to be true for clubfoot outcomes.
doi:10.1007/s11832-007-0037-1
PMCID: PMC2656724  PMID: 19308490
Congenital vertical talus; Flatfoot; Treatment; Genetics; Etiology
3.  Conservative treatment of subtalar dislocations 
International Orthopaedics  2001;26(1):56-60.
Abstract.
Forty-five patients who presented between 1983 and 1998 with acute closed dislocation of the subtalar joint were selected for this study. There were 37 medial and eight lateral dislocations. The mean follow-up was 7.5 years (range: 2–17 years). The mean American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) at follow-up was 84. Subtalar fusion was required in one patient with persistent severe hindfoot instability. There was no significant difference in the AOFAS score between medial and lateral subtalar dislocations. We conclude that pure subtalar dislocation produced by low energy trauma, promptly reduced and immobilised for 4 weeks has a favourable long-term outcome.
doi:10.1007/s002640100296
PMCID: PMC3620856  PMID: 11954852
4.  Weaver syndrome associated with bilateral congenital hip and unilateral subtalar dislocation 
Hippokratia  2010;14(3):212-214.
Background: Weaver syndrome is a congenital paediatric syndrome characterized by mental, respiratory and musculoskeletal manifestations. The coexisting deformities of the skull, the face, fingers and toes are typical. We report a case of a girl with Weaver syndrome associated with rare bilateral congenital dislocation of the hips associated with congenital hypoplastic talus and subtalar dislocation of her ankle joint.
Case Report: A 3-year old girl was admitted in our department with typical manifestations of Weaver syndrome, associated with congenital dislocation of bilateral hips, hypoplastic talus and subtalar dislocation of her right ankle. She was in pain while standing upright and incapable of independent walking. Both hips were treated operatively with open reduction and bilateral iliac osteotomy. Two years afterwards she had an open reduction of her talus and extraarticular arthrodesis of her subtalar joint in her right ankle. Six years postoperatively after the hip operations and four years after the ankle operation the girl is ambulant with a painless independent and unaided walking with a mild limp and full range of movements in all the operated joints.
Conclusions: We suggest that children with Weaver syndrome and disabling musculosceletal deformities, particularly affecting their ability to stand up and walk should be treated early, before bone maturity, in order to achieve the best potential musculoskeletal as well as developmental outcome.
PMCID: PMC2943362  PMID: 20981173
Weaver Syndrome; congenital dislocation; hip; ankle
5.  Posterior ankle and subtalar arthroscopy: indications, technique, and results 
Over the decades, arthroscopy has grown in popularity for the treatment of many foot and ankle pathologies. While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/subtalar arthroscopy is still a relatively new procedure. The goal of this review is to outline the indications, surgical techniques, and results of posterior ankle/subtalar arthroscopy. The main indications include: 1) osteochondral lesions (of subtalar and posterior ankle joint); 2) posterior soft tissue or bony impingement; 3) os trigonum syndrome; 4) posterior loose bodies; 5) flexor hallucis longus (FHL) tenosynovitis; 6) posterior synovitis; 7) subtalar (or ankle) joint arthritis; 8) posterior tibial, talar, or calcaneal fractures (for arthroscopic reduction and internal fixation). Although posterior ankle/subtalar arthroscopy has shown to be safe and effective in the treatment of many of the above mentioned conditions, thorough knowledge of the anatomy, correct indications, and a precise surgical technique are essential to produce good outcomes.
doi:10.1007/s12178-012-9118-y
PMCID: PMC3535152  PMID: 22426574
Posterior ankle arthroscopy; Subtalar arthroscopy; Prone arthroscopy; Osteochondral lesions; Os trigonum; Posterior arthroscopic subtalar arthrodesis; Talocalcaneal coalitions; Foot and ankle
6.  Medial swivel dislocation of the talonavicular joint 
Indian Journal of Orthopaedics  2009;43(1):87-89.
Medial swivel dislocation, a variant of subtalar dislocation is uncommon. A 35 years old male presented after 6 weeks old injury to left ankle following motor cycle accident. He had pain, swelling around ankle and was unable to bear weight on left foot. Clinical examination revealed diffuse swelling and tenderness in mid foot region. His plain X rays and CT scan showed talonavicular dislocation with compression defect of the head of the talus. He was treated by open reduction and K-wire fixation. At 32 months follow up foot was painless, stable with normal range of ankle and subtalar motion.
doi:10.4103/0019-5413.45329
PMCID: PMC2739503  PMID: 19753187
Medial swivel dislocation; subtalar-subluxation; talonavicular dislocation
7.  Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results 
Background
Subtalar dislocation is a rare injury, with the medial type occurring in the majority of cases. The period of postreduction immobilization is a matter of controversy. Most studies set the period of immobilization between 4 and 8 weeks. The hypothesis in this study is that a period of 2–3 weeks of immobilization in a cast, followed by early mobilization, could provide better functional results than longer periods of immobilization.
Materials and methods
During a period of 4 years, eight patients (six men, two women) with mean age of 37.2 years and uncomplicated medial subtalar dislocation were treated in our institution. Immediate reduction under sedation and cast immobilization was provided in all cases. Our rehabilitation protocol consisted of two completed weeks of immobilization and thereafter ankle range-of-motion exercises and partial weight-bearing mobilization. Patients were followed up for a mean period of 3 years. Clinical results were evaluated using the AOFAS Ankle–Hindfoot scale.
Results
All patients achieved almost normal ankle range of motion and good clinical outcome (mean AOFAS score 92.25). No radiographic evidence of arthritis or avascular necrosis of the talus was detected. Two patients complained of mild pain of the hindfoot. All patients returned to daily routine activities in about 2 months from injury.
Conclusions
Immediate reduction and early mobilization could be key factors for uneventful recovery of uncomplicated medial subtalar dislocation. Multicenter clinical trials are needed for further validation of our initial results.
Level of evidence
III, prospective clinical series study.
doi:10.1007/s10195-011-0126-2
PMCID: PMC3052431  PMID: 21308390
Subtalar joint; Dislocations; Ankle; Foot; Rehabilitation
8.  Early mobilization after uncomplicated medial subtalar dislocation provides successful functional results 
Background
Subtalar dislocation is a rare injury, with the medial type occurring in the majority of cases. The period of postreduction immobilization is a matter of controversy. Most studies set the period of immobilization between 4 and 8 weeks. The hypothesis in this study is that a period of 2–3 weeks of immobilization in a cast, followed by early mobilization, could provide better functional results than longer periods of immobilization.
Materials and methods
During a period of 4 years, eight patients (six men, two women) with mean age of 37.2 years and uncomplicated medial subtalar dislocation were treated in our institution. Immediate reduction under sedation and cast immobilization was provided in all cases. Our rehabilitation protocol consisted of two completed weeks of immobilization and thereafter ankle range-of-motion exercises and partial weight-bearing mobilization. Patients were followed up for a mean period of 3 years. Clinical results were evaluated using the AOFAS Ankle–Hindfoot scale.
Results
All patients achieved almost normal ankle range of motion and good clinical outcome (mean AOFAS score 92.25). No radiographic evidence of arthritis or avascular necrosis of the talus was detected. Two patients complained of mild pain of the hindfoot. All patients returned to daily routine activities in about 2 months from injury.
Conclusions
Immediate reduction and early mobilization could be key factors for uneventful recovery of uncomplicated medial subtalar dislocation. Multicenter clinical trials are needed for further validation of our initial results.
Level of evidence
III, prospective clinical series study.
doi:10.1007/s10195-011-0126-2
PMCID: PMC3052431  PMID: 21308390
Subtalar joint; Dislocations; Ankle; Foot; Rehabilitation
9.  Simultaneous Bilateral Fracture Dislocation of the Talus: A Case Report 
Trauma Monthly  2013;18(2):90-94.
Introduction
Fracture - dislocations of the talus are typically due to high energy injuries. Displaced fracture - dislocations of the talus have poor outcomes in general and complications are common. Although talar fracture is common and comprises the second most common tarsal fracture, bilateral fracture - dislocations of the talus are rare. Not many reports regarding the subject can be found in the literature.
Case Presentation
We report a patient with bilateral fracture - dislocations of the talus treated by open reduction and internal fixation. This patient was a 25 year-old man who sustained bilateral fracture - dislocation of the talus due to a motor vehicle accident.
Conclusions
Bilateral talar fracture - dislocation is rare. The surgical approach discussed together with the pathomechanics of this injury can yield good short term results.
doi:10.5812/traumamon.11228
PMCID: PMC3860673  PMID: 24350160
Dislocation; Talus; Fracture Fixation, Internal
10.  Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft 
Sixteen patients underwent minimally invasive subtalar arthrodesis through a mini-invasive approach with posterior iliac graft between 2004 and 2006. No hardware was used to transfix the arthrodesis and partial weight bearing was allowed immediately. The primary indication for surgery was the squeal of fracture os calcis in terms of subtalar joint arthritis, loss of heel height, malalignment of the hindfoot, and pain with weight bearing. There were 12 male and 4 female patients with a mean age of 30 (range 17–52). Patients were followed up for a period of 40.8 months (range 36–48 months). The mean interval from injury to fusion was 2 (+0.6) years ranging from 6 months to 6 years post fracture. The average clinical rating scale based on the American Orthopaedic Foot and Ankle Society (AOFAS) improved from 36 preoperatively to 78 at the latest follow-up (P < 0.05). Union rate was 94%. Radiographic evaluation revealed a mean increase in calcaneal inclination of 6.25 + 8.3° (P < 0.07) and a mean increase in the lateral talocalcaneal angle of 7.42 + 10.2° (P < 0.08). Complications were graft nonunion in 1 patient and transient tendoachilles tendinitis in another. This technique can be used to decrease the morbidity associated with the late complications of os calcis fractures by aligning the hindfoot, restoring the heel height and correcting calcaneal and talar inclination. It offers the advantage of early weight bearing while avoiding hardware complications.
doi:10.1007/s11751-010-0081-0
PMCID: PMC2839322  PMID: 20360876
Subtalar arthrodesis; Os calcis fracture; Minimally invasive; Posterior iliac crest bone; Grafting
11.  Minimally invasive, no hardware subtalar arthrodesis with autogenous posterior iliac bone graft 
Sixteen patients underwent minimally invasive subtalar arthrodesis through a mini-invasive approach with posterior iliac graft between 2004 and 2006. No hardware was used to transfix the arthrodesis and partial weight bearing was allowed immediately. The primary indication for surgery was the squeal of fracture os calcis in terms of subtalar joint arthritis, loss of heel height, malalignment of the hindfoot, and pain with weight bearing. There were 12 male and 4 female patients with a mean age of 30 (range 17–52). Patients were followed up for a period of 40.8 months (range 36–48 months). The mean interval from injury to fusion was 2 (+0.6) years ranging from 6 months to 6 years post fracture. The average clinical rating scale based on the American Orthopaedic Foot and Ankle Society (AOFAS) improved from 36 preoperatively to 78 at the latest follow-up (P < 0.05). Union rate was 94%. Radiographic evaluation revealed a mean increase in calcaneal inclination of 6.25 + 8.3° (P < 0.07) and a mean increase in the lateral talocalcaneal angle of 7.42 + 10.2° (P < 0.08). Complications were graft nonunion in 1 patient and transient tendoachilles tendinitis in another. This technique can be used to decrease the morbidity associated with the late complications of os calcis fractures by aligning the hindfoot, restoring the heel height and correcting calcaneal and talar inclination. It offers the advantage of early weight bearing while avoiding hardware complications.
doi:10.1007/s11751-010-0081-0
PMCID: PMC2839322  PMID: 20360876
Subtalar arthrodesis; Os calcis fracture; Minimally invasive; Posterior iliac crest bone; Grafting
12.  Therapeutic management of complicated talar extrusion: literature review and case report 
Total extrusion of the talus with interruption of all ligaments (missing talus) is a rare injury. We describe the case of a 27-year-old man who reported total extrusion of the talus after a motorbike accident with interruption of all talar ligaments. In the first repair effort, the articular void left by the talus was filled with antibiotic cement and the wound was closed primarily. Nevertheless, the skin overlying the talar joint displayed necrosis. In order to cover the cutaneous defect, improve local vascularization, and allow reimplantation of the talus, a sural fasciocutaneous island flap was harvested. Subsequently, the original talus was placed and arthrodesis of the subtalar joint was performed. The patient was able to walk bearing full weight without support equipment after 6 months. Several therapeutic options have been suggested in such cases, including replacing the talus, tibiocalcaneal arthrodesis, and pseudoarthrodesis. The rarity and peculiarity of such cases make the establishment of generalized guidelines an arduous task, leaving the choice of treatment to the surgeon, in conformity with each case’s peculiarity. In this case use of the flap may have promoted the vascularization of the reimplanted talus, thus avoiding avascular necrosis and allowing successful reimplantation of the original talus.
doi:10.1007/s10195-011-0129-z
PMCID: PMC3052426  PMID: 21350893
Total talar dislocation; Talar extrusion; Missing talus; Distally-based sural fasciocutaneous flap
13.  Therapeutic management of complicated talar extrusion: literature review and case report 
Total extrusion of the talus with interruption of all ligaments (missing talus) is a rare injury. We describe the case of a 27-year-old man who reported total extrusion of the talus after a motorbike accident with interruption of all talar ligaments. In the first repair effort, the articular void left by the talus was filled with antibiotic cement and the wound was closed primarily. Nevertheless, the skin overlying the talar joint displayed necrosis. In order to cover the cutaneous defect, improve local vascularization, and allow reimplantation of the talus, a sural fasciocutaneous island flap was harvested. Subsequently, the original talus was placed and arthrodesis of the subtalar joint was performed. The patient was able to walk bearing full weight without support equipment after 6 months. Several therapeutic options have been suggested in such cases, including replacing the talus, tibiocalcaneal arthrodesis, and pseudoarthrodesis. The rarity and peculiarity of such cases make the establishment of generalized guidelines an arduous task, leaving the choice of treatment to the surgeon, in conformity with each case’s peculiarity. In this case use of the flap may have promoted the vascularization of the reimplanted talus, thus avoiding avascular necrosis and allowing successful reimplantation of the original talus.
doi:10.1007/s10195-011-0129-z
PMCID: PMC3052426  PMID: 21350893
Total talar dislocation; Talar extrusion; Missing talus; Distally-based sural fasciocutaneous flap
14.  Delayed surgical treatment for neglected or mal-reduced talar fractures 
International Orthopaedics  2005;29(5):326-329.
From 1993 to 2002, we treated nine patients for neglected or mal-reduced talar fractures. Average patient age was 39 (20–64) years and average follow-up 53 months. The time interval between injury and index operation ranged from 4 weeks to 4 years. Surgical procedures included open reduction with or without bone grafting in six cases, open reduction combined with ankle fusion in one case, talar neck osteotomy in one case, and talar neck osteotomy combined with subtalar fusion in one case. All cases had solid bone union. One patient developed avascular necrosis of the talus needing subsequent ankle arthrodesis. In six patients, adjacent hindfoot arthrosis occurred. The overall AOFAS ankle–hindfoot score was in average 77.4. We conclude that in neglected and mal-reduced talar fractures, surgical treatment can lead to a favourable outcome if the hindfoot joints are not arthritic.
doi:10.1007/s00264-005-0675-1
PMCID: PMC3456640  PMID: 16094539
15.  Gradual Reduction of Chronic Fracture Dislocation of the Ankle Using Ilizarov/Taylor Spatial Frame 
HSS Journal  2010;7(1):85-88.
With the advances in trauma care, chronic fracture dislocation of the ankle is not a condition commonly seen in modern clinical practice. When encountered, it can be difficult to preserve the ankle joint. We present a case of a 65-year-old female, with a chronic fracture dislocation of the ankle. The ankle joint was subluxated with posterior translation of the talus, displacement of the posterior malleolus fragment, and a distal fibula fracture. A minimally traumatic approach was devised to treat this complex fracture dislocation which included gradual reduction of the ankle with a Taylor spatial frame, followed by stabilization with internal fixation and removal of the frame. Bony union and restoration of the ankle joint congruency was achieved.
doi:10.1007/s11420-010-9166-z
PMCID: PMC3026112  PMID: 22294963
ankle fracture; ankle dislocation; neglected ankle fracture; Ilizarov; Taylor spatial frame
16.  Congenital vertical talus: Treatment by reverse ponseti technique 
Indian Journal of Orthopaedics  2008;42(3):347-350.
Background:
The surgery for idiopathic congenital vertical talus (CVT) can lead to stiffness, wound complications and under or over correction. There are sporadic literature on costing with mixed results. We describe our early experience of reverse ponseti technique.
Materials and methods:
Four cases (four feet) of idiopathic congenital vertical talus (CVT) which presented one month after birth were treated by serial manipulation and casting, tendoachilles tenotomy and percutaneous pinning of talonavicular joint. An average of 5.2 (range - four to six) plaster cast applications were required to correct the forefoot deformity. Once the talus and navicular were aligned based on the radiographic talus-first metatarsal axis, percutaneous fixation of the talo-navicular joint with a Kirschner wire, and percutaneous tendoachilles tenotomy under anesthesia was performed following which a cast was applied with the foot in slight dorsiflexion.
Results:
The mean follow-up period for the four cases was 8.5 months (6-12 months). At the end of the treatment all feet were supple and plantigrade but still using ankle foot orthosis (AFO). The mean talocalcaneal angle was 70 degrees before treatment and this reduced to 31 degrees after casting. The mean talar axis first metatasal base angle (TAMBA) angle was 60° before casting and this improved to 10.5°.
Conclusion:
Although our follow-up period is small, we would recommend early casting for idiopathic CVT along the same lines as the Ponseti technique for clubfoot except that the forces applied are in reverse direction. This early casting method can prevent extensive surgery in the future, however, a close vigil is required to detect any early relapse.
doi:10.4103/0019-5413.41860
PMCID: PMC2739479  PMID: 19753164
Casting; congenital vertical talus; conservative treatment
17.  Biomechanical and Neuromuscular Effects of Ankle Taping and Bracing 
Journal of Athletic Training  2002;37(4):436-445.
Objective: An extensive review of clinically relevant research is provided to assist clinicians in understanding the underlying mechanisms by which various ankle-support systems may provide beneficial effects. Strategies for management of different types of ankle ligament conditions are also discussed.
Background: Much of the literature pertaining to ankle instability and external support has focused on assessment of inward displacement of the hindfoot within the frontal plane. Some researchers have emphasized the importance of (1) pathologic rotary displacement of the talus within the transverse plane, (2) the frequent presence of subtalar joint ligament lesions, and (3) the interrelated effects of ankle support on deceleration of inversion velocity and facilitation of neuromuscular response.
Description: The traditional method for application of adhesive tape to the ankle primarily restricts inward displacement of the hindfoot within the frontal plane. The biomechanical rationale for a method of ankle taping that restricts lower leg rotation and triplanar displacement of the foot associated with subtalar motion is presented.
Clinical Advantages: The lateral subtalar-sling taping procedure may limit strain on the anterior talofibular ligament associated with subtalar inversion, restrain anterolateral rotary subluxation of the talus in the presence of ligament laxity, and protect the subtalar ligaments from excessive loading. The medial subtalar sling may reduce strain on the anterior-inferior tibiofibular syndesmosis and enhance hindfoot-to-forefoot force transfer during the push-off phase of the gait cycle.
PMCID: PMC164375  PMID: 12937565
ankle instability; subtalar joint injury; ankle dysfunction
18.  A new perspective on management of open calcaneus fractures 
International Orthopaedics  2007;32(6):785-790.
The treatment protocol of closed calcaneal fractures has been described in the literature extensively. However, treatment of open calcaneal fractures has not been discussed in detail. Various treatment alternatives have been suggested including external fixator, primary subtalar distraction arthrodesis, and partial calcanectomy according to the type of fracture. We have retrospectively reviewed 36 adult patients with 39 open calcaneal fractures who were treated with our new philosophy. Average follow-up time was 9.29 years (range, 1.25–28 years). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used in functional evaluation. The average score was 77.9 (range, 67–92). All of the patients had limited subtalar movement. We propose an algorithm for the management of open calcaneus fractures, although treatment largely depends on the physical status of the patient, type of the fracture, localisation of the open wound and the surgeon’s choice.
doi:10.1007/s00264-007-0402-1
PMCID: PMC2898954  PMID: 17581751
19.  Closed total talus dislocation without fracture: a case report 
Cases Journal  2009;2:9132.
Total dislocation of the talus from all of its joints is a rare injury specially when the talus and malleoli are not fractured and frequently it is as a result of a high-energy trauma. It usually leads to degenerative changes in neighboring joints and frequently avascular necrosis is a predictable outcome. We present a case of total talus dislocation because of a high-energy trauma in association with other major fractures resulting from a fall from height, but no fracture could be detected in the talus and any of malleols. Closed reduction was unsuccessful and we performed open reduction. At 6 month post operation follow-up, the talus didn't show subluxation and avascular necrosis could not be detected.
doi:10.1186/1757-1626-2-9132
PMCID: PMC2803929  PMID: 20062649
20.  Total Dislocation of the Talus without a Fracture. Open or Closed Treatment? Report of Two Cases and Review of the Literature 
Complete dislocation of the talus not accompanied by a fracture is a very rare injury. The injury is encountered as a closed one even more rarely. Reviewing the literature we found that proposed treatments for total talus dislocation varied from primary talectomy or arthodesis (to avoid complications) to closed reduction and an under knee cast. Most importantly, there was no agreement among authors about the method of reduction (open/closed). We report our experience with two cases of closed total talus dislocation not accompanied by a fracture, and review the literature to retrieve evidence on whether a closed or open treatment should be preferred for this type of injury.
doi:10.2174/1874325000903010052
PMCID: PMC2707762  PMID: 19590615
Talus; total dislocation; treatment.
21.  Metrecom Measurement of Navicular Drop in Subjects with Anterior Cruciate Ligament Injury 
Journal of Athletic Training  2000;35(4):403-406.
Objective:
Research suggests that excessive pronation of the foot contributes to the incidence of anterior cruciate ligament (ACL) tears by increasing internal tibial rotation. Studies have documented greater navicular drop values in individuals with a history of an ACL tear using methods that may not accurately follow the motion of underlying bone. The purpose of our investigation was to compare the navicular drop of subjects with a history of ACL tears with healthy controls when measured by a Metrecom.
Subjects:
Eighteen subjects previously diagnosed with a torn ACL were matched by age, sex, and limb to noninjured control subjects.
Design and Setting:
Static group comparisons of navicular drop in subjects with an injured ACL and subjects having no history of ACL injury.
Measurements:
A single investigator performed the measure of navicular drop. The position of the navicular tuberosity was digitized while the subject stood barefoot on a flat surface in subtalar joint neutral and in relaxed stance. Intrarater reliability was assessed using intraclass correlation coefficient and standard error of the measurement. An independent t test assessed the difference between the amount of navicular drop in the ACL group and the controls.
Results:
Analysis of repeated measures, intraclass correlation coefficient (2,1), demonstrated intrarater reliability for the measure of navicular drop to be 0.90; the standard error of measurement was 1.19 mm. The independent t test showed a statistically greater amount of navicular drop in the ACL group.
Conclusions:
Excellent intrarater reliability was demonstrated when using the Metrecom to measure navicular drop. Excessive subtalar joint pronation, measured as navicular drop, was identified as 1 factor that may contribute to ACL injury.
Images
PMCID: PMC1323364  PMID: 16558652
pronation; internal tibial rotation; navicular bone
22.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis
23.  Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion 
Abstract
A retrograde nail with posterior-to-anterior (PA) locking into os calcis, talus and tibia was used to correct deformity and achieve fusion after failed fusion. A variety of methods have been published to achieve union of the ankle and subtalar joint in a failed fusion situation. We have studied a retrograde locking nail technique through a 2.5-cm incision in the non-weightbearing part of the sole of the foot. Remaining cartilage in the ankle joint, where necessary, was percutaneously removed through an anterior approach and the locking nail was inserted after reaming of os calcis, talus and tibia. Locking screw insertion was in the sagittal plane (p.a. direction), in talus os calcis and tibial diaphysis using a nail mounted jig. Ten patients were entered in the study (age 27-60 years). The initial aetiology for attempted fusion was post-traumatic in nine cases and rheumatic in one case. There were 25 previous operations in the cohort not leading to fusion. An additional temporary external fixator was used in four cases to reach and maintain the optimum position for the procedure. The intervention time was 30-75 min. Dynamisation of the nail was performed after four months under local anaesthesia. The mean duration of follow-up was 4 years (3-5.5 years). Radiologically and clinically, fusion was achieved in 16 weeks (range, 12-20 weeks). There was no loosening of the implant or implant failure. A leg length discrepancy was avoided using this technique. There was one complication with varus malunion in a heavy smoker which united after corrective osteotomy, revision nailing and bone grafting. Patient satisfaction was measured on a scale (not visual analogue) of 0 (not satisfied) to 10 (completely satisfied); overall satisfaction averaged 9.5 points (range, 6-10 points). The postoperative ankle-hindfoot score of the American Orthopedic Foot and Ankle Society averaged 73.5 points (range, 61-81 points). Retrograde locked nailing with locking in the sagittal plane is a reliable minimally invasive procedure to achieve fusion of the ankle and the subtalar joint after failed fusion.
doi:10.1007/s11751-007-0018-4
PMCID: PMC2321722  PMID: 18427914
Ankle arthrodesis; Failed fusion; Retrograde nail; Calcaneotalotibial arthrodesis
24.  Medial subtalar dislocation 
International Orthopaedics  1999;23(6):366-367.
Abstract 
We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was succesfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless.
doi:10.1007/s002640050396
PMCID: PMC3619837  PMID: 10741528
25.  Ankle reconstruction in type II fibular hemimelia 
Ankle reconstruction prior to limb lengthening for was performed in 13 patients with fibular hemimelia with complete radiological absence of the fibula (type II). There were different degrees of absence of metatarsal rays. The hindfoot deformity was a heel valgus in 12 patients and equinovarus in 1 patient. The patients’ ages ranged from 9 to 26 months. Excision of the fibular anlage was performed with lateral subtalar and ankle soft tissue releases to restore the ankle and subtalar joint relationships. In all cases, the fibular anlage ended distally in a cartilaginous lateral malleolar remnant that was fused to the talus in two patients. This fibular remnant was advanced distally and fixed to the tibia with 2 Kirschner wires to recreate an ankle mortise. The period of follow-up ranged from 12 to 38 months. All patients had a stable ankle without tendency to valgus deformity or subluxation. The ankle range of movement was a mean of 27.3° plantarflexion (25–30) and 18° dorsiflexion (15–20). Reconstruction of the ankle in type II fibular hemimelia using advancement of the cartilaginous lateral malleolar remnant has produced encouraging results in the short-term but longer follow-up is needed.
doi:10.1007/s11751-012-0129-4
PMCID: PMC3332325  PMID: 22434224
Fibular hemimelia; Ankle reconstruction

Results 1-25 (431207)