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Fractures of the talus
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
These injuries are the most common accounting for 50% of talar fractures and typically are the result of high energy injuries such as falls from a height or car accidents. The neck is the apex of the medial longitudinal arch, and the structure is at risk with forced dorsiflexion of the ankle. The fracture occurs as a result of the neck being forced against the distal tibia. This was the mechanism first described by Anderson in 1919 who coined the term “Aviator's Astragalus”.
Treatment of distal intra-articular/extra-articular tibial fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Vasileios P. Giannoudis, Peter V. Giannoudis
It has to be appreciated that the timing of fixation of distal tibia fractures is dictated by the state of the soft tissues. It is common practice, even in low-energy trauma injuries in the elderly, to apply a staged protocol where the facture is temporarily stabilized with a splint or an external fixator until the soft tissues are amenable to operative intervention. The presence of wrinkles and epithelialization of fracture blisters are usually the clinical signs prompting the surgeon to proceed to definitive fixation of the fracture.
Musculoskeletal Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
Complete structural and functional evaluation of the ankle joint is best undertaken by subspecialist sonographers and radiologists. It is possible, however, to look for an ankle joint effusion. Position the patient on the bed with their foot plantarflexed (toes pointed down) and place a linear, high-frequency probe over the anterior aspect of the ankle joint in the longitudinal plane (see Figure 7.8). This should afford you a view of the anterior aspect of the ankle joint and you should be able to see the distal tibia articulating with the dome of the talus (see Figure 7.9). An excess of hypoechoic fluid within the joint space is in keeping with an ankle joint effusion. Again, using colour Doppler to look for hyperaemia can be helpful to raise suspicion of septic arthritis.
Study and numerical analysis of Von Mises stress of a new tumor-type distal femoral prosthesis comprising a peek composite reinforced with carbon fibers: finite element analysis
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Standing and squatting are two typical movement states in the process of human movement. In the standing position, the weight of an adult of 70 kg is simulated, and 700 N synthetic stress is applied to the femoral head vertically, and the displacement and rotation angle of each node of the distal tibia are fully restrained in three directions (X-axis, Y-axis, Z-axis). When the knee is flexed at 90°, the stress can reach 4 times the body weight. Therefore, when the knee is flexed, a synthetic stress of 2800 N is applied to the femoral head vertically, and the displacement and rotation angle of each node of the distal tibia are fully restrained in three directions (X-axis, Y-axis, Z-axis) (Figure 1D). The reason for choosing the restriction of the distal tibia is that the distal tibia is immobile under the stress state of standing and squatting.
Effectiveness of ankle fusion in patients with hemophilia, advanced ankle degeneration, and unbearable pain for whom nonsurgical and surgical treatments have been ineffective
Published in Expert Review of Hematology, 2021
E. Carlos Rodriguez-Merchan, Carlos A. Encinas-Ullan, Primitivo Gomez-Cardero
There are several approaches for treating hemophilic ankle problems in the initial phases of degeneration of the articular cartilage in the event that hematologic prophylaxis is unsuccessful in achieving no hemorrhaging. Treatment should begin with nonsurgical methods, such as taping, intra-articular injections of hyaluronic acid and corticosteroids, physical medicine and rehabilitation programs, and PTB orthoses [30]. If these approaches are unsuccessful, radiosynovectomy should be indicated. The next step is ankle-preserving surgical treatment: excision of the anterior osteophyte of the distal tibia by open surgery or arthroscopic surgery and debridement of the ankle by arthroscopic surgery. If these techniques also fail in the final phases of degeneration of the articular cartilage (severe arthropathy), the last resort is also surgery but not ankle-preserving; ankle fusion and total ankle arthroplasty are indicated.
Predictive value of magnetic resonance imaging for multifocal osteonecrosis screening associated with glucocorticoid therapy
Published in Modern Rheumatology, 2020
Kento Nawata, Junichi Nakamura, Shigeo Hagiwara, Yasushi Wako, Michiaki Miura, Yuya Kawarai, Masahiko Sugano, Kensuke Yoshino, Kazuhide Inage, Sumihisa Orita, Seiji Ohtori
The site and the extent of osteonecrosis were classified based on the 2001 revised criteria of the JMHLW [15] as follows: type A was defined as a lesion that occupied the medial one-third or less of the weight-bearing portion of the femoral head; a type B lesion occupied the medial two-thirds or less of the weight-bearing portion of the femoral head; a type C1 lesion occupied more than the medial two-thirds of the weight-bearing portion of the femoral head but did not extend laterally to the acetabular edge and a type C2 lesion extended laterally to the acetabular edge. Osteonecrosis of the knee was divided into six regions in accordance with the classifications of Shigemura et al. [16] as follows: distal femoral metaphysis (DFM), femoral lateral condyle (FLC), femoral medial condyle (FMC), tibial lateral condyle (TLC), tibial medial condyle (TMC) and proximal tibial metaphysis (PTM) (Figure 1). The risk of knee joint collapse with osteonecrosis increased when four or more regions were involved (Group F) rather than when three or fewer regions were implicated (Group T) [16]. Osteonecrosis of the shoulder included the humeral head and the glenoid fossa (Figure 2(A)). Osteonecrosis of the ankle included the distal tibia and talus (Figure 2(B)).