Outcome of Pantalar Fusion With Femoral Head Allograft in Avascular Necrosis of Talus

Ramu, Thiru Karthikeyan; Bajuri, Mohd Yazid; Hayyun, Muhammad Fathi; Mazli, Norliyana

doi:10.3389/fsurg.2021.658788

Front. Surg.

2021

DOI: 10.3389/fsurg.2021.658788

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Outcome of Pantalar Fusion With Femoral Head Allograft in Avascular Necrosis of Talus

Thiru Karthikeyan Ramu

Mohd Yazid Bajuri

Muhammad Fathi Hayyun

et al.

Abstract: Background: Avascular necrosis (AVN) of the talus is a challenging condition that is caused primarily by trauma. The severity of the talus fracture determines the risk of AVN. Severe osteonecrosis with the loss of talar integrity can be treated with arthrodesis and structural bone graft.Method: This study shows the experience of pantalar arthrodesis using hindfoot arthrodesis nail, screw fixation, and femoral head allograft in four patients.Result: All patients were satisfied in terms of pain and function afte… Show more

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Cited by 4 publications

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Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Kubisa,

Pałka

et al. 2024

Medicina

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Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I–II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III–IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR.

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Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Kubisa,

Pałka

et al. 2024

Medicina

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Post-traumatic avascular necrosis of the talus

Deme,

Fruja,

Hreniuc

et al. 2024

Rom J Morphol Embryol

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In this comprehensive case report, we examine a 29-year-old male who suffered a high-energy vehicular accident, resulting in a type III Hawkins fracture of the talus. This specific fracture type is critically associated with a greater than 90% risk of progressing to avascular necrosis (AVN) of the talus, a severe and debilitating condition. Alongside this, the patient sustained fractures of the medial and lateral malleolus. Due to extensive swelling and severe circulatory disorders, an immediate emergency surgical procedure was necessitated, employing nail fixation as a stabilizing intervention. Over the course of 12 months following the surgery, despite routine post-operative imaging including X-rays and computed tomography (CT) scans, the patient continued to experience significant pain and impairment. This condition led to further investigations, culminating in a magnetic resonance imaging (MRI) that revealed an area of 19.8/20.9 mm of AVN on the talus dome’s upper-lateral facet. Interestingly, earlier CT scans had indicated multiple osteitic lesions, but these findings lacked a clear clinical correspondence, presenting a diagnostic challenge. To resolve this ambiguity and to definitively distinguish between necrosis and infection, a targeted histopathological analysis was deemed necessary. This analysis was conducted on a bone fragment extracted during a follow-up surgical procedure for nail removal. The results from this analysis present an area of bone and myeloid tissue necrosis unequivocally confirming the presence of AVN, effectively ruling out osteitis as a potential diagnosis. This critical diagnostic clarification allowed for a shift in therapeutic strategy, enabling the initiation of a more focused and potentially curative treatment regimen.

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Limb Salvage for Charcot Neuroarthropathy of the Ankle Joint: A Case Series

Primadhi¹,

Utoyo²,

Budi³

2023

Journal of Foot and Ankle Surgery (Asia Pacific)

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Outcome of Pantalar Fusion With Femoral Head Allograft in Avascular Necrosis of Talus

Cited by 4 publications

References 11 publications

Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Avascular Necrosis of the Talus: Diagnosis, Treatment, and Modern Reconstructive Options

Post-traumatic avascular necrosis of the talus

Limb Salvage for Charcot Neuroarthropathy of the Ankle Joint: A Case Series

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