Lower extremity fractures
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
Talus fractures are rare in children and may occur through both high- and low-energy mechanisms [91, 92]. They often occur during a fall from a significant height that dorsiflexes the ankle, allowing the talar neck to impinge against the anterior aspect of the distal tibia. Care must be taken to look for other injuries due to the severe trauma required to cause this fracture. Severe swelling may be present, so compartment syndrome of the foot should be considered. Standard AP, lateral, and oblique x-rays of the foot should be obtained. A CT and/or MRI should be obtained to better assess the fracture pattern and displacement. An MRI may be especially helpful in young children since much of their talus is still cartilage. Treatment of talus fractures depends on the age of the child, the fracture pattern, and its displacement. Younger children have the potential to remodel, so anatomic reduction and stabilization of the fracture may not be required. talar fractures in adolescents are more commonly treated surgically with recommendations similar to those for treatment of adult fractures. Avascular necrosis of the talar body and posttraumatic arthritis are the most significant complications of talar fractures [91, 92].
Foot fractures
Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth in Musculoskeletal Trauma in the Elderly, 2016
Biomechanically, the talus links motion of the foot to the leg allowing gait to proceed from heel strike to toe lift. At the talocrural joint it allows dorsiflexion and plantar flexion. At the syndesmosis, during dorsiflexion, it produces external rotation of the fibula and internal rotation during plantar flexion. Through the subtalar joint, it contributes to flexion-abduction and extension-adduction of the hind-foot. It also contributes to pronation and supination as part of the transverse tarsal or Chopart’s joint at the midfoot. Therefore, malalignment can compromise motion of the ankle, subtalar and transverse tarsal joints.
A to Z Entries
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The talus is common to both the ankle and the foot, forming the distal part of the ankle joint and the proximal part of the subtalar joint. The distal ends of the tibia and fibula, the malleoli, form the proximal part of the ankle joint and can be used to approximate the ankle joint axis in vivo. The ankle joint axis passes just distal to the tips of the malleoli. According to Inman (1976), the ankle joint axis lies, on average, 5 mm distal to the tip of the medial malleolus, and 3 mm distal and 8 mm anterior to the tip of the lateral malleolus.
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)).
Simulated anterior translation and medial rotation of the talus affect ankle joint contact forces during vertical hopping
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Given that most ankle sprains occur during participation in sports that involve jumping and landing activities, there is a need to study the relationship between talus position and joint loads during activities that are more dynamic than gait. For example, a previous study reported that ankle joint reaction force during jump-landing motion reached almost 10 times body weight (Cleather et al. 2013) compared to about 4-6 times body weight during walking (Procter and Paul 1982; Valente et al. 2014). Studying more dynamic movements would also be important because abnormal talus alignments may also affect the directions of the vector components of the ankle joint force (e.g., shear force and compression force), which may have implications for abnormal loading and long-term musculoskeletal conditions such as ankle OA. However, little literature studies the influence of the talus alignment on ankle joint contact forces (AJF) during high-force dynamic tasks.
Traumatic jejunal perforation associated with SARS-CoV-2 (COVID-19) infection
Published in Baylor University Medical Center Proceedings, 2021
Jonathan Kopel, Luong Linda, Irfan Warraich, Grant Sorensen, Gregory L. Brower
The patient had two large lacerations in the right periorbital region. An obvious open right ankle fracture with the talus extruded from the ankle wound and deformity to the right thumb were noted. Computed tomography (CT) of the head showed a large subgaleal hematoma with areas of active bleeding in the right frontoparietal region measuring up to 9 cm in the transverse and 2 cm in the vertical dimensions, without underlying calvarial fracture. No acute intracranial abnormality or fracture in the cervical spine was noted. CT of the body with contrast showed a small amount of free fluid in the right paracolic gutter and the cul-de-sac. There was a nondisplaced fracture of the left first rib. The patient had an elevated white blood cell count (14,760/mm3), with neutrophilia (12,720/mm3) and lymphopenia (1,170/mm3). She was also found to be positive for COVID-19 using the Abbott ID NOW COVID-19 rapid nucleic acid amplification test from nasal swab samples collected before surgery. The patient did not report any symptoms related to COVID-19 or recall any known exposures or contacts.