Objective To discuss the etiology, cl inical manifestation, imaging, staging, and treatment of bone necrosis of the second metatarsal head, the navicular bone, and the talus so as to provide more information for cl inical appl ication. Methods The related home and abroad l iterature concerning bone necrosis of the second metatarsal head, the navicular bone, and the talus in recent years was reviewed extensively. And the cl inical manifestation, imaging, staging, and treatment were summarized and analyzed. Results Bone necrosis of the second metatarsal head, the navicular bone, and thetalus were more closely related to the particular anatomy; the environmental and genetic factors also lead to such diseases. The cl inical presentation was typically local pain and swell ing around the joint, frequently with restricted joint motion in severe cases. Both radiographs and MRI were used to be the main criteria for diagnosis and staging of these diseases. According to different phases, conservative therapy was effective in treating osteonecrosis at early stage. While surgical treatments such as osteotomy, fixation, and arthrodesis were used in late-stage bone necrosis. Conclusion The current methods of treatment have achieved good effect, but long-term cl inical follow-up is needed and the new surgery should be further studied.
Objective To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral “safe zone” for Hawkins type Ⅰ-Ⅲ talar neck fractures. Methods A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral “safe zone” parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups (P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. Results The operation time in the study group was significantly shorter than that in the control group (P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant (P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups (P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups (P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients’ satisfaction in the study group were significantly better than those in the control group (P<0.05). ConclusionThe treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral “safe zone” can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.
Objective To explore the operative method and effectiveness of talocalcaneal coal ition.Methods Between July 2008 and October 2010, 10 patients with talocalcaneal coal ition were treated, including 2 cases ofcongenital talocalcaneal coal ition and 8 cases of secondary talocalcaneal coal ition. There were 4 males and 6 females, aged53.5 years on average (range, 16-70 years). Three patients had middle-facet talocalcaneal coal ition and 7 had posterior-facettalocalcaneal coal ition. The preoperative visual analogue score (VAS) was 9.0 ± 0.4. According to American OrthopedicFoot and Ankle Society (AOFAS) hindfoot scale, the score was 42.4 ± 1.4. Two cases compl icated by subtalar degeneration.Resection of the bone bar and fat packing were performed in 8 cases of simple talocalcaneal coal ition, and resection and subtalararthrodesis in 2 cases of talocalcaneal coal ition combined with subtalar degeneration. Results Primary healing of incisionswas obtained in all patients. Eight patients were followed up 18 months on average (range, 12-36 months). At last follow-up,VAS was 2.0 ± 0.7, showing siginificant difference when compared with preoperative score (t=6.425, P=0.000). AOFAS score was86.9 ± 2.3, showing significant difference when compared with preoperative score (t=7.634, P=0.000). The X-ray films showedthat no recurrence of talocalcaneal coal ition was observed in patients underdoing simple removal of bone bar, and bone fusionwas observed in patients undergoing arthrodesis. Conclusion To achieve satisfactory outcomes for talocalcaneal coal ition, areasonable surgical procedure should be chosen according to the specific facet and complication.
ObjectiveTo summarize the surgical treatment methods for avascular necrosis of the talus. Methods The recent domestic and international literature related to avascular necrosis of the talus was extensively conducted. The pathogenesis, surgical treatment methods, and prognosis were summarized. Results The clinical symptoms of avascular necrosis of the talus at early stage are not obvious, and most patients have progressed to Ficat-Arlet stages Ⅲ-Ⅳ and require surgical treatment. Currently, surgical treatments for this disease include core decompression, vascularized bone flap transplantation, arthroplasty, and arthrodesis, etc. Early avascular necrosis of the talus can be treated conservatively, and if treatment fails, core decompression can be considered. Arthrodesis is a remedial surgery for patients with end-stage arthritis and collapse, and in cases of severe bone loss, tibiotalocalcaneal arthrodesis and bone grafting are required. Vascularized bone flap transplantation is effective and plays a role in all stages of avascular necrosis of the talus, but the appropriate donor area for the flap still needs further to be studied. ConclusionThe surgical treatment and the system of treatment for different stages of avascular necrosis of the talus still need to be refined.
目的:研究距骨骨折螺旋CT轴扫、多平面(MPR)和三维(3D)重建图像的特点及其临床意义。方法:收集距骨骨折患者术前螺旋CT资料12例,同时进行了MPR和3D重建图像。着重分析距骨骨折线的走行、与关节面的关系、关节面塌陷程度等,并评价轴扫、MPR和3D重建图像的优势。结果:在12例距骨骨折者骨踝关节受累7例。MPR和3D重建图像可直观显示骨折详细情况。结论:螺旋CT轴扫、多平面和三维重建图像相结合,可更好显示距骨骨折的情况,能为临床术前诊断和治疗提供有价值的影像信息。
ObjectiveTo summarize the research progress of surgical procedures in osteochondral lesions of the talus (OLT).MethodsBy consulting the related literature of OLT in recent years, the advantages and disadvantages of various surgical treatment schemes were analyzed and summarized.ResultsThere are many surgical treatments for OLT, including bone marrow stimulation, osteochondral transplantation, autologous chondrocyte transplantation, and biologically assisted therapy. Various schemes have different indications and limitations. With the continuous development of various technologies, the effectiveness of OLT treatment will gradually improve.ConclusionThere are still many difficulties and controversies in the treatment of OLT, and there is no unified treatment plan. It is suggested that individualized operation plan should be formulated according to the specific conditions of patients.
ObjectiveTo investigate the effectiveness of arthroscopic talocalcaneal coalition resection in painful adults via a modified posterior approach.MethodsBetween January 2015 and December 2017, 9 patients with painful talocalcaneal coalition accepted arthroscopic resection via the posterior malleolus high lateral observation approach combined with the lower medial operation approach. Of them, 6 were male and 3 were female, aged from 19 to 30 years (mean, 24 years). Among them, 2 cases had no definite local trauma and 7 cases had a history of sprain of foot and ankle. The disease duration ranged from 6 to 30 months, with a median of 12 months. Rozansky classification of talocalcaneal coalition for the 9 patients: 5 cases (5 feet) were type Ⅰ, 2 cases (2 feet) type Ⅱ, and 2 cases (2 feet) type Ⅲ. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films and CT scans of the ankle joint during follow-up. The visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score were used to evaluate the effectiveness.ResultsThe operation time was 60-90 minutes (mean, 76 minutes). All patients were followed up 12-24 months (mean, 18 months). All the incisions healed by first intention, without infection, skin necrosis, lower extremity deep vein thrombosis, vascular nerve and tendon injury, bone bridge recurrence, and other complications. The ankle function recovered well and the pain was relieved obviously after operation, and the patients returned to work at 3-5 months after operation, with an average of 3.9 months. At last follow-up, the VAS score was 0.7±0.5, which was significantly improved (t=20.239, P=0.000) when compared with preoperative score (4.2±0.5); the AOFAS ankle-hind foot score was 94±4, which was significantly improved (t=−27.424, P=0.000) when compared with preoperative score (62±2). According to AOFAS ankle-hindfoot scoring system, the results were excellent in 7 cases and good in 2 cases at last follow-up.ConclusionIt is more intuitive, more space, and more flexibility for operation via the modified posterior malleolus high lateral observation approach combined with the lower medial operation approach in talocalcaneal coalition. It is feasible to remove talocalcaneal coalition programmatically according to the specific anatomic signs during the operation.
OBJECTIVE: To study a new kind of operation for displaced talar neck fractures. METHODS: From April 1996 to March 2001, 9 talar neck fractures were treated by internal fixation of absorbable lag screw with a medial approach and cut of medial malleolus to expose the fractures. A non-weight-bearing below-knee cast was applied for 6 to 12 weeks after operation. Once union of the fracture site is apparent, the patient should remain non-weight bearing in a removable short-leg and keep exercise every day. RESULTS: All the patients received follow-up from 15 to 60 months with an average of 28 months. The fractures healed from 20 to 42 weeks. The excellent and good rate of function was 77.8% (7/9) according to American Orthopedic Foot and Ankle Society Score(AOFAS). One case had the complication of superficial infection of wound and skin edge necrosis after operation, which was Hawkins type III. Late complication included two cases of avascular necrosis(AVN). Among them, one AVN of Hawkins type II was caused by early weight-bearing five weeks after operation and gained the fair score. The other AVN of Hawkins type III was inefficient to conservative therapy and proceeded ankle fusion in the end. The AOFAS of the patient was bad. CONCLUSION: Treatment of talar neck fractures by internal fixation of absorbable lag screw with a medial approach is an ideal method. It can gain a satisfactory result by the operation, strict postoperative care and rehabilitation.