Conservative and Surgical Treatment of Talar Fractures: A Systematic Review and Meta-Analysis on Clinical Outcomes and Complications

Saravi, Babak; Lang, Gernot; Ruff, Robert L.; Schmal, Hagen; Südkamp, Norbert P.; Ülkümen, Sara; Zwingmann, J.

doi:10.3390/ijerph18168274

Cited by 11 publications

(10 citation statements)

References 70 publications

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“…Increased exposure, sufficient space, and joint locking; these factors are advantageous for the reduction of displaced fracture fragments. For fracture patients, there may be damage to the deltoid ligament complex the tibialis anterior, the tibialis posterior, the flexor hallucis longus, and the flexor digitorum longus [ 3 , 10 ]. Additionally, muscle relaxation under anesthesia can lead to a larger surgical exposure area, which is beneficial for improving the visualization of the fracture fragments [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The talus is composed of a head, neck, and body, with an extremely irregular shape, and the majority of it is covered by articular cartilage [ 2 ]. Most talar fractures are caused by violent trauma such as falls from height or car accidents [ 3 ]. Furthermore, talar fractures are often associated with ankle fractures, severe soft tissue damage, calcaneal fractures, and metatarsal fractures.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

Li,

Wang,

Han

et al. 2024

PLoS ONE

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Background Talar fractures often require osteotomy during surgery to achieve reduction and screw fixation of the fractured fragments due to limited visualization and operating space of the talar articular surface. The objective of this study was to evaluate the horizontal approach to the medial malleolus facet by maximizing exposure through dorsiflexion and plantarflexion positions. Methods In dorsiflexion, plantarflexion, and functional foot positions, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. The talar model from Mimics was imported into Geomagic software for image refinement. Then Solidworks software was used to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated. Results The mean total area of the "semicircular" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2. In the functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2, respectively. In dorsiflexion, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2. In plantarflexion, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2. The mean overlap area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2. The mean percentage of the increased exposure area in dorsiflexion and plantarflexion were 36.71 ± 3.25% and 15.13 ± 2.83%. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of the posterior tibiotalar portion of the deltoid ligament complex was 4.53 ± 0.64 mm. Conclusions Within the 3D model, we measured the exposed area of the medial malleolus facet in different positions and the anatomic location of the insertion point at the medial malleolus groove. When the foot is in plantarflexion or dorsiflexion, a sufficiently large area and operating space can be exposed during surgery. The data regarding the exposed visualization area and virtual screws need to be combined with clinical experience for safer reduction and fixation of fracture fragments. Further validation of its intraoperative feasibility will require additional clinical research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

Li,

Wang,

Han

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Ebraheim et al [ 6 ] demonstrated 38% incidence of AVN after surgical treatment for talar body fractures and Lindvall et al [ 19 ] operatively treated 26 cases of isolated, displaced talar neck and body fractures, reporting that the findings of AVN were seen in 13 cases (50%). Although the incidence of AVN in talar body fractures is reported to vary considerably, many authors agree that the degree of fracture displacement is associated with the incidence of AVN [ 20 ]. However, it has been reported that the incidence of AVN is related to not only the degree of displacement but also poor original blood supply in the talar body and the surgical approach [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Talar Body Fracture Treated by Hindfoot Endoscopic Reduction and Internal Fixation

Shimmyo

Morimoto

Tachibana

et al. 2022

Case Reports in Orthopedics

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Background. A talar body fracture is relatively rare. Surgical treatment for the fracture is generally indicated for the displaced fracture types and traditionally performed via open approaches. However, open approaches may not be able to achieve adequate exposure of the talus body owing to the difficulty in achieving reduction and fixation of the fracture. In this case report, we describe a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. Case report. A 39-year-old man who was a carpenter complained of right hindfoot pain after he fell from a stepladder during work. Although plain radiographs of the right ankle showed no abnormal findings, noncontrast computed tomography demonstrated a fracture line from the lateral side of the posterior lateral process to the medial side of the talus body. In addition, the fracture line extended to the posterior ankle and subtalar joints, and the bone fragment was slightly displaced. We diagnosed him with the talar body fracture and performed operative treatments using hindfoot endoscopic reduction and internal fixation. At 14 weeks after the operation, he was able to return to work at the preinjury activity level without dysfunction of the ankle nor complications. Conclusion. We reported a case of talar body fracture treated by hindfoot endoscopic reduction and internal fixation. In this case, the hindfoot endoscopic technique provided visualization of the fracture site with less invasiveness and increased safety, which enabled proper reduction and internal fixation of the fracture site. Therefore, the patient was able to return to work at the preinjury activity level at 14 weeks after surgery without dysfunction of the ankle nor complications. This surgical technique may be a useful option for the talar body fracture.

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“…Furthermore, talar fractures are often associated with ankle fractures, severe soft tissue damage, calcaneal fractures, and metatarsal fractures. These can disrupt the ankle joint's mobility system and lead to complications such as ischemic necrosis, arthritis, deformities, etc [3][4][5][6][7]. Therefore, talar fractures should be stabilized, anatomically reduced and rmly xed as early as possible [8,9].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

Li,

Wang,

Han

et al. 2023

Preprint

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Background Talar fractures often require osteotomy during surgery to achieve reduction and screw fixation of the fractured fragments due to limited visualization and operating space of the talar articular surface. The objective of this study was to evaluate the horizontal approach to the medial malleolus facet by maximizing exposure through dorsiflexion and plantarflexion positions. Methods In the positions of foot dorsiflexion, plantarflexion, and functional, we respectively obtained the anterior and posterior edge lines of the projection of the medial malleolus on the medial malleolar facet. Import the talar model from Mimics into Geomagic software for image refinement. Utilize Solidworks software to segment the medial surface of the talus and extend the edge lines from the three positions to project them onto the "semicircular" base for 2D projection. The exposed area in different positions, the percentage of total area it represents, and the anatomic location of the insertion point at the groove between the anteroposternal protrusions of the medial malleolus were calculated. Results The mean total area of the "semicircular" region on the medial malleolus surface of the talus was 542.10 ± 80.05 mm2; In functional position, the exposed mean area of the medial malleolar facet around the medial malleolus both anteriorly and posteriorly was 141.22 ± 24.34 mm2, 167.58 ± 22.36mm2. In dorsiflexion position, the mean area of the posterior aspect of the medial malleolar facet was 366.28 ± 48.12 mm2 ; In plantarflexion position, the mean of the anterior aspect of the medial malleolar facet was 222.70 ± 35.32 mm2; The mean area of unexposed area in both dorsiflexion and plantarflexion was 23.32 ± 5.94 mm2; The mean percentage of the increased exposure area in dorsiflexion (36.71 ± 3.25 %) and plantarflexion positions were 36.71 ± 3.25 % and 15.13 ± 2.83 %. The mean distance from the insertion point to the top of the talar dome was 10.69 ± 1.24 mm, to the medial malleolus facet border of the talar trochlea was 5.61 ± 0.96 mm, and to the tuberosity of medial malleolus facet of deltoid ligament posterior tibial talar was 4.53 ± 0.64 mm. Conclusions Within the 3D model, we measured the exposed area of the medial malleolus facet in different positions and the anatomic location of the insertion point at the medial malleolus groove. The data regarding the exposed visualization area and virtual screws need to be combined with clinical experience for safer reduction and fixation of fracture fragments. Further validation of its intraoperative feasibility will require additional clinical research.

show abstract

Conservative and Surgical Treatment of Talar Fractures: A Systematic Review and Meta-Analysis on Clinical Outcomes and Complications

Cited by 11 publications

References 70 publications

Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

Talar Body Fracture Treated by Hindfoot Endoscopic Reduction and Internal Fixation

Evaluation of the horizontal approach to the medial malleolar facet in sagittal talar fractures through dorsiflexion and plantarflexion positions

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