Vascular Disruption of the Talus

Phisitkul, Phinit; Haugsdal, Jaclyn; Vaseenon, Tanawat; Pizzimenti, Marc A.

doi:10.1177/1071100713479318

Cited by 30 publications

(6 citation statements)

References 33 publications

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“…24 In a cadaveric study, a dual-incision approach allowed better access to the calcaneocuboid joint with less vascular disruption to the talus compared to a single medial incision approach. 97 Other surgeons prefer a lateral-only incision, which has rates of deformity correction, wound complications, and pain comparable to the dual-incision approach. 85,94 Given the concern for postoperative rigidity as well as the risk of nonunion, some surgeons have tried to spare the calcaneocuboid joint.…”

Section: Double/triple Arthrodesismentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

148

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Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.

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Section: Double/triple Arthrodesismentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

148

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“…One factor that may contribute to a lower fusion rate of the subtalar joint in patients with prior tibiotalar arthrodesis, is the potential of altered vascularization of the talus caused by the surgical approach for the tibiotalar arthrodesis. 10,26,33 The vascularization of the talus is known to be precarious, and the anterior approach between the tibialis anterior tendon and the extensor hallucis longus tendon may sacrifice important branches of the dorsalis pedis artery. 24 Furthermore, the subsequent subtalar arthrodesis also disrupts the tarsal sinus artery.…”

Section: Discussionmentioning

confidence: 99%

“…24 Furthermore, the subsequent subtalar arthrodesis also disrupts the tarsal sinus artery. 26 As a result, 2 of the 3 main arteries responsible for the vascularization of the talus can be potentially compromised. This is one reasonable hypothesis why we generally see lower fusion rate of the subtalar joint in patients with prior tibiotalar arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Subtalar Arthrodesis in Patients With Prior Tibiotalar Arthrodesis for Posttraumatic Osteoarthritis

Theunissen

Birch

Reymond³

et al. 2023

Foot Ankle Int.

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Background: The tibiotalar arthrodesis for end-stage ankle osteoarthritis is a surgical procedure that leads to a modification of the kinematics of the adjacent joints and may result in the development of secondary osteoarthritic degeneration of the subtalar joint. It has previously been observed that subtalar arthrodesis in this context shows a lower fusion rate than isolated subtalar arthrodesis. This retrospective study reports the results of subtalar joint arthrodesis with previous ipsilateral tibiotalar arthrodesis and suggests some factors that may compromise the fusion of the joint. Methods: Between September 2010 and October 2021, 15 arthrodeses of the subtalar joint with screw fixation were performed in 14 patients, with a fusion of the ipsilateral tibiotalar joint. Fourteen of 15 cases used an open sinus tarsi approach, 13 were augmented with iliac crest bone graft, and 11 had supplemental demineralized bone matrix (DBM). The outcome variables were fusion rate, time to fusion, and revision rate. Fusion was assessed by radiographs and computed tomography scan. Results: Twelve of the 15 subtalar arthrodeses (80%) fused at the first attempt with an average fusion time of 4.7 months. Conclusion: In this limited retrospective case series, compared to the fusion rate of isolated subtalar arthrodesis reported in the literature, the rate of subtalar fusion in the presence of an ipsilateral tibiotalar arthrodesis was found to be lower. Level of Evidence: Level IV, retrospective case series.

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“…Avascular necrosis of the talus has been described following talonavicular arthrodesis via the medial approach due to injury to the deltoid artery. 9,17 Although this is a rare complication, use of the dorsal approach could also reduce this risk of damage to the vulnerable talar blood supply.…”

Section: Discussionmentioning

confidence: 99%