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Asran Y, Mutungi T, Shirodkar K, Hegde G, Shamshuddin S, Proctor R, Naqvi J, Knowles D, Ali I. Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Lower Limb Trauma. J Comput Assist Tomogr 2025; 49:313-326. [PMID: 39761496 DOI: 10.1097/rct.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2025]
Abstract
ABSTRACT Computed tomography plays an ever-increasing role in the management of fractures and dislocations due to its capability in efficiently providing multiplanar reformats and 3-dimensional volume rendered images. It can reveal findings that are occult on plain radiography and therefore allow for more accurate decision making with regard to fracture classification and management. Clinical radiologists play a critical role in facilitating the processing of imaging to provide adequate image reformats in the desired planes, producing 3 dimensional images but most crucially identifying pertinent findings, which will contribute between the selection of nonoperative and operative management and potentially influence surgical technique. In an earlier article we have outlined the key findings that the radiologist should search for in major upper limb fractures and dislocations. In this second article we focus on the pelvis, acetabulum, femur, tibia, ankle, and foot and through a case-based approach provide a succinct overview of radiological findings that can play an important role in determining patient management.
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Affiliation(s)
| | | | - Kapil Shirodkar
- Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham
| | - Ganesh Hegde
- Department of Radiology, Royal National Orthopaedic Hospital NHS Foundation Trust, Stanmore
| | - Sameer Shamshuddin
- Department of Radiology, University Hospitals of Morecambe Bay NHS Trust, Lancaster
| | - Robin Proctor
- Department of Radiology, University Hospitals of Morecambe Bay NHS Trust, Lancaster
| | - Jawad Naqvi
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester
| | - David Knowles
- Department of Trauma and Orthopaedics, University Hospitals of Morecambe Bay NHS Trust, Lancaster, United Kingdom
| | - Imran Ali
- Department of Trauma and Orthopaedics, University Hospitals of Morecambe Bay NHS Trust, Lancaster, United Kingdom
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Brushtein E, Partio N, Huttunen TT, Repo JP, Mäenpää H, Mattila VM. Epidemiology of talus fractures in Finland: a nationwide register study from 1997 to 2020. BMC Musculoskelet Disord 2024; 25:1031. [PMID: 39702100 DOI: 10.1186/s12891-024-08141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 12/02/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND The aim of this study was to estimate the nationwide incidence of talus fractures (per 100 000 person-years) and to determine the incidence of operative treatment in the Finnish population. METHODS Based on Finnish Care Register for Health Care data, all patients 18 years and older admitted to hospital with talar fractures between 1997 and 2020 were included. RESULTS During the 24-year study period, 5247 patients with primary or secondary diagnoses of talar fracture were identified. The mean incidence during the whole study period was 50.4 per 100 000 person-years. There was a clear increase starting from the year 2009 (61.4 per 100 000 person-years), that continued and the incidence in 2018 raised up to 106.8 person-years. The total incidence of operations performed on talar fractures remained almost the same during the study period (9.1 per 100 000 person-years from 1997 to 2020). CONCLUSIONS While the incidence of performed operations had remained stable, the incidence of talar fractures in Finland has increased during the last decades. The increase was more prominent in men. The observed change is possibly due to the progress and availability of computer tomography. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Evgenii Brushtein
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland.
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Kuntokatu 2, Tampere, 33520, Finland.
| | - Nikke Partio
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Tuomas T Huttunen
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jussi P Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heikki Mäenpää
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Abar B, Kim MS, Adams SB, Adams WR, Amendola A, Easley ME, Ellington JK, Ford SE, Hanselman AE, Highlander P, Kwon JY, Miller CP, Nunley JA, Parker C, Parekh SG, Schweitzer KM, Shawen SB, Mann T, Kelly C. Initial Safety of Total Talus Replacement Used to Treat Talar Avascular Necrosis. Foot Ankle Int 2024; 45:1258-1265. [PMID: 39462286 DOI: 10.1177/10711007241278947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
BACKGROUND Total talus replacement (TTR) implants are designed to replace the diseased talar anatomy, reduce pain, maintain ankle range of motion, and restore ankle function after conservative treatments have failed. Currently TTR implants are produced by 3D printing a patient-specific implant designed from the patient's preoperative anatomy. TTR surgery using patient-specific implants is a relatively new technique that remains understudied in the literature. Therefore, the purpose of this investigation was to determine the early safety and potential benefit of the TTR implant in patients with talar avascular necrosis. METHODS This retrospective, multicenter, cohort study evaluates the safety and potential benefits of TTR using 3D-printed patient-specific implants across 4 US centers. The primary outcome was the occurrence of early adverse events after TTR surgery. Secondary outcomes including, pain, and physical function were assessed using the pain visual analog scale (VAS), and Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF), respectively. RESULTS The study team analyzed 15 patients with more than 1 year of follow-up. The mean duration of follow-up was 25.9 months (range: 18.3-41 months). Although 33.3% (5 of 15) of patients experienced adverse events, primarily occurring within the initial 6 months postoperatively, 93% (14 of 15) of patients reported implant survivorship. Of the 5 cases (33.3%) resulting in an adverse event, 3 (60.0%) were determined to be unrelated to the subject device, 2 (40.0%) were determined to be possibly procedure-related, and none (0%) were determined to be device-related. CONCLUSION Although further studies are needed to compare TTR with the standard of care, the results of this study demonstrate the relative early safety of TTR surgery using a 3D-printed implant for the treatment of challenging talar pathologies. A larger and longer clinical study is required to see if the efficacy of this approach will be statistically and clinically meaningful.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Y Kwon
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Claire Parker
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Lindner C, Reyes P, Molina E, Olave A. Beyond the imaging evaluation of fractures of the lateral process of the talus: Let's not forget concomitant injuries. World J Clin Cases 2024; 12:6410-6412. [PMID: 39464318 PMCID: PMC11438680 DOI: 10.12998/wjcc.v12.i30.6410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Fractures of the lateral process of the talus (FLPT) are uncommon fractures that represent a clinical challenge. Traditional radiological classification systems rely predominantly on radiographic findings. However, due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs, novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries, thereby optimizing patient management and reducing the incidence of long-term complications.
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Affiliation(s)
- Cristian Lindner
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Biobío, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Pedro Reyes
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Biobío, Chile
- Department of Musculoskeletal Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Eduardo Molina
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Biobío, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
| | - Andrés Olave
- Department of Radiology, Faculty of Medicine, University of Concepción, Concepción 4030000, Biobío, Chile
- Department of Radiology, Hospital Regional Guillermo Grant Benavente, Concepción 4030000, Biobío, Chile
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Crim J. Bone radiographs: sometimes overlooked, often difficult to read, and still important. Skeletal Radiol 2024; 53:1687-1698. [PMID: 37914896 DOI: 10.1007/s00256-023-04498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Julia Crim
- University of Missouri at Columbia, Columbia, MO, USA.
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Yung KS, Kwok HM, Pan NY, Lo BA. Acute traumatic subtalar dislocation: A rare but important clinical entity with 15-year retrospective radiological analysis of 23 cases. J Clin Imaging Sci 2024; 14:30. [PMID: 39157203 PMCID: PMC11301796 DOI: 10.25259/jcis_8_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/28/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives The objectives of this study were to contribute to the limited existing knowledge about subtalar dislocations, analyze the computed tomography (CT) findings and advantages over radiography, and report the rate and potential risk factors of post-traumatic peri-talar osteoarthritis (OA). Material and Methods A total of 23 cases of traumatic subtalar dislocation during a 15-year period at three regional hospitals were retrospectively reviewed. Results All 23 cases were closed dislocations. Successful close reduction was performed in 17 patients (73.9%) and 6 patients (26.1%) required open reduction and internal fixation. Twenty patients (87%) had associated foot and ankle fractures. Fractures of calcaneal medial tubercle were the most common (75%), followed by talar head (30%), sinus tarsi (25%), and medial malleolus (25%). The radiograph's sensitivity for identifying fractures was 48.1%. The mean follow-up period is 30 months. Symptomatic OA affected 8 patients (36.4%). No post-trauatic talar avascular necrosis was noted. Fractures were present in all of those patients with post-traumatic OA (100%). Three out of five patients who sustained high-energy mechanism injury developed radiographic OA (66.7%). Three out of six patients (50%) treated with open reduction and internal fixation also developed radiographic OA. Conclusion Subtalar dislocation remains a rare injury. It is strongly associated with foot and ankle fractures. Fractures of the calcaneal medial tubercle were the most common. The risk of post-traumatic symptomatic peritalar OA is high. CT is useful in detecting occult fractures and injured bony subregions. We postulated potential risk factors of post-traumatic OA (fracture, high-energy mechanism of injury, open reduction, and internal fixation); however, this requires further study.
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Affiliation(s)
- King Shing Yung
- Department of Radiology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Hoi Ming Kwok
- Department of Radiology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Nin Yuan Pan
- Department of Radiology, Princess Margaret Hospital, Kwai Chung, Hong Kong
| | - Bill Archie Lo
- Department of Radiology, Tseung Kwan O Hospital, Hang Hau, Hong Kong
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Griffin JT, Landy DC, Mechas CA, Nazal MR, Foster JA, Moghadamian ES, Srinath A, Aneja A. The Hawkins Sign of the Talus: The Impact of Patient Factors on Prediction Accuracy. J Bone Joint Surg Am 2024; 106:958-965. [PMID: 38512980 DOI: 10.2106/jbjs.23.00906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Osteonecrosis is a complication of talar neck fractures associated with chronic pain and poor functional outcomes. The Hawkins sign, the radiographic presence of subchondral lucency seen in the talar dome 6 to 8 weeks after trauma, is a strong predictor of preserved talar vascularity. This study sought to assess the accuracy of the Hawkins sign in a contemporary cohort and assess factors associated with inaccuracy. METHODS A retrospective review of talar neck fractures at a level-I trauma center from 2008 to 2016 was conducted. Both the Hawkins sign and osteonecrosis were evaluated on radiographs. The Hawkins sign was determined on the basis of radiographs taken approximately 6 to 8 weeks after injury, whereas osteonecrosis was determined based on radiographs taken throughout follow-up. The Hawkins sign accuracy was assessed using proportions with 95% confidence intervals (CIs), and associations were examined with Fisher exact testing. RESULTS In total, 105 talar neck fractures were identified. The Hawkins sign was observed in 21 tali, 3 (14% [95% CI, 3% to 36%]) of which later developed osteonecrosis. In the remaining 84 tali without a Hawkins sign, 32 (38% [95% CI, 28% to 49%]) developed osteonecrosis. Of the 3 tali that developed osteonecrosis following observation of the Hawkins sign, all were in patients who smoked. CONCLUSIONS A positive Hawkins sign may not be a reliable predictor of preserved talar vascularity in all patients. We identified 3 patients with a positive Hawkins sign who developed osteonecrosis, all of whom were smokers. Factors impairing the restoration of microvascular blood supply to the talus may lead to osteonecrosis despite the presence of preserved macrovascular blood flow and an observed Hawkins sign. Further research is needed to understand the factors limiting Hawkins sign accuracy. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jarod T Griffin
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Charles A Mechas
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Mark R Nazal
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Jeffrey A Foster
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | - Eric S Moghadamian
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Arjun Srinath
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida
| | - Arun Aneja
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
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Cheruvu MS, Narayana Murthy S, Siddiqui RS. Subtalar dislocations: Mechanisms, clinical presentation and methods of reduction. World J Orthop 2023; 14:379-386. [PMID: 37377991 PMCID: PMC10292063 DOI: 10.5312/wjo.v14.i6.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
Subtalar joint is a complex joint in hindfoot formed by the talus superiorly and the calcaneus and navicular inferiorly. Subtalar dislocations are high-mechanism injuries, which are caused by simultaneous dislocation of both talonavicular and talocalcaneal joints, without major fracture of the talus. They are usually classified as medial (most common), lateral, anterior and posterior dislocations, based on the position of foot in relation to talus and the indirect forces that have been applied to cause this significant injury. They are usually diagnosed by X rays, but computed tomography and magnetic resonance imaging can be used to identify associated intra-articular fractures and peri-talar soft tissue injuries respectively. Majority being closed injuries, can be managed in ED by closed reduction and cast immobilisation, but if they are open, have poor outcomes. Complications that ensue open dislocations are post-traumatic arthritis, instability and avascular necrosis.
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Affiliation(s)
- Manikandar Srinivas Cheruvu
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Sanjay Narayana Murthy
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital NHS Trust, Stoke-On-Trent ST4 6QG, United Kingdom
| | - Raheel Shakoor Siddiqui
- Department of Orthopaedics, Birmingham Heartlands Hospital, Birmingham Birmingham Heartlands Hospital, United Kingdom
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9
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Liawrungrueang W, Wongsiri S, Sarasombath P. Endoscopic carpal surgery in carpal tunnel syndrome: A systematic review. SAGE Open Med 2023; 11:20503121231177111. [PMID: 37324119 PMCID: PMC10262635 DOI: 10.1177/20503121231177111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Endoscopic carpal tunnel release has become increasingly popular and has shown the advantage of early recovery of hand function with minimal morbidity. In this systematic review, we aimed to summarize the currently available data and describe the reported advantages and disadvantages of endoscopic carpal tunnel surgery for treating carpal tunnel syndrome. Methods In this study, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which is a set of reporting requirements for systematic reviews and meta-analyses. The search strategy with MeSH terms was "MeSH (carpal tunnel syndrome) AND (endoscopic)" Filters: in the last 5 years, English-on February 27th, 2022. A total of 131 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 39 that matched the criteria, of which 14 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. Results A total of 14 studies met the eligibility criteria. Analysis of those studies found that all types of portals in endoscopic carpal tunnel release reduced postoperative pain at a short-term follow-up. There was no evidence to suggest the superiority of the single- or two-portal techniques in terms of outcomes. In terms of pain relief, symptom resolution, patient satisfaction, duration to return to work, and adverse events, this early use of endoscopic carpal tunnel release produced satisfactory outcomes. Further studies comparing the number of portals are needed. Conclusion Endoscopic carpal tunnel surgery for treating carpal tunnel syndrome is effective and both single- and dual-portal techniques provide advantages in terms of early recovery and minimal morbidity.
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Affiliation(s)
- Wongthawat Liawrungrueang
- Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand
- Division of Research, School of Medicine, University of Phayao, Phayao, Thailand
| | - Sunton Wongsiri
- Department of Orthopaedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Peem Sarasombath
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Park EH, de Cesar Netto C, Fritz J. MRI in Acute Ankle Sprains: Should We Be More Aggressive with Indications? Foot Ankle Clin 2023; 28:231-264. [PMID: 37137621 DOI: 10.1016/j.fcl.2023.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA; Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA.
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Anazor FC, Dhinsa BS. Traumatic subtalar joint dislocation. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 36848162 DOI: 10.12968/hmed.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. Failure of urgent reduction might lead to increased risk of conversion to an open injury as a result of pressure necrosis of the overlying skin, risk of talar avascular necrosis and risk of neurovascular compromise. A computed tomography scan is needed in all cases following successful closed or open reduction to identify associated occult foot and ankle fractures. The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.
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Affiliation(s)
- Fitzgerald C Anazor
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, UK.,Postgraduate Medical Education Directorate, Nottingham University NHS Foundation Trust, UK
| | - Baljinder S Dhinsa
- Department of Trauma and Orthopaedics, William Harvey Hospital, Ashford, UK
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12
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McCoy CA, Hughes R. Will you review this patient with an open ankle injury? J Accid Emerg Med 2023; 40:100-156. [PMID: 36693663 DOI: 10.1136/emermed-2022-212660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Christopher Andrew McCoy
- Emergency Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Richard Hughes
- Emergency Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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13
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Talar neck and body fracture outcomes: a multicentre retrospective review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:99-105. [PMID: 34807327 DOI: 10.1007/s00590-021-03161-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/01/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Talar neck and body fractures are uncommon injuries that are challenging to manage with high reported complication rates, including post-traumatic arthritis, avascular necrosis, and poor functional outcomes. The aim of this study was to assess the complication rates for patients with talus fractures across three major trauma centres (MTCs) in England. METHODS A retrospective analysis was performed of prospectively collected trauma databases. Data were collected from three English MTCs. Patients with talar neck and/or body fractures sustained between August 2015 and August 2019 were identified and their clinical course reviewed radiologically and clinically. Isolated process fractures, osteochondral defects and paediatric patients were excluded. Patients were analysed by fracture type and for definitive treatment method with separation into non-operative and operative management groups. Procedure type was identified in the operative group. Superficial infection, deep infection, non-union, avascular necrosis, post-traumatic arthritis and removal of metalwork rates were analysed. RESULTS Eighty-five patients with talar neck and/or body fractures were included. Seventy-five patients received operative management, 10 non-operative. The overall AVN rate was 5.9% (five patients), overall post-traumatic arthritis rate was 18.8% (16 patients), deep infection rate 1.2% (one patient), non-union rate 4.7% (four patients). Removal of metalwork rate was 9.4% (eight patients). CONCLUSION Our reported outcomes and complication rates are generally lower than those previously described. This may be a result of improved techniques, a higher frequency of open reduction with direct visualisation or by surgery occurring in centralised specialist centres.
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14
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Presurgical Perspective and Postsurgical Evaluation of Calcaneal and Talus Fractures. Semin Musculoskelet Radiol 2022; 26:635-643. [PMID: 36791733 DOI: 10.1055/s-0042-1760119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Fractures of the calcaneus and talus are severe injuries that usually result from high-energy trauma. The calcaneus and talus are essential for the transmission of body weight, so an optimal reduction and/or fixation of fractures is required to prevent disabling consequences. These fractures almost always have an articular involvement, and an anatomical reduction is required; any residual step-off would lead to joint incongruity and secondary arthrosis.The aims of imaging are first, to guide management by describing the fracture characteristics (e.g., location, displacement, fragments, articular involvement, soft tissue compromise), and second, to detect early and late surgical complications (e.g., infection, malunion, nonunion, arthrosis, hardware issues). Although radiographs remain the first-line imaging modality for the screening of ankle and foot trauma, computed tomography is almost always required for the initial management and follow-up of the patient.
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15
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Yang H, Liao L, Xue F, Li Y, Hu G. Anatomical observation, classification, fracture and finite element analysis of the posterior process of the Asian adult talus. J Orthop Surg Res 2022; 17:444. [PMID: 36209168 PMCID: PMC9548205 DOI: 10.1186/s13018-022-03345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fractures of the posterior process of the talus are rarely seen and frequently overlooked. In our study, anatomical observation and classification of the posterior process of the talus were carried out, and related imaging and finite element methods were combined. The study aimed to observe and provide anatomical data related to posterior process of talus in Asian adults and explore the potential relationships between the different types with fracture of posterior process of talus. METHODS Combined with the anatomical morphology and imaging data, the posterior process of talus was divided into four types, and the incidence and fracture situation were statistically analyzed. The finite element models of four different types of talus processes were established and verified, and the stress and strain were simulated and analyzed. RESULTS The total incidence of the posterior process of the talus was 97.47%. The proportions of the four types were neck-like 10.13%, flat 36.29%, pointy 12.66% and round blunt 38.39%. The overall incidence of bone cracks of the posterior process of the talus was 4.98%; the most common type was neck-like type. Compared with the value on the other types, the maximum von Mises stress increased by 67.66%, 83.90% and 111.18% on the neck-like posterior process of talus respectively. CONCLUSIONS It is speculated that different types of the posterior process of the talus may be related to the probability of fracture, and it may be better to consider different treatment strategies for different types of fractures.
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Affiliation(s)
- Han Yang
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838, North of Guangzhou Great Road, BaiYun District, Guangzhou, 510515, Guangdong Province, China
| | - Liqing Liao
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838, North of Guangzhou Great Road, BaiYun District, Guangzhou, 510515, Guangdong Province, China
| | - Fan Xue
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838, North of Guangzhou Great Road, BaiYun District, Guangzhou, 510515, Guangdong Province, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838, North of Guangzhou Great Road, BaiYun District, Guangzhou, 510515, Guangdong Province, China.
| | - Guanyu Hu
- The Third Affiliated Hospital of Southern Medical University, No. 183, West of Zhongshan Avenue, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
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16
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Aydıngöz Ü, Yıldız AE, Ergen FB. Zero Echo Time Musculoskeletal MRI: Technique, Optimization, Applications, and Pitfalls. Radiographics 2022; 42:1398-1414. [PMID: 35904982 DOI: 10.1148/rg.220029] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Zero echo time (ZTE) imaging is an MRI technique that produces images similar to those obtained with radiography or CT. In ZTE MRI, the very short T2 signal from the mineralized trabecular bone matrix and especially cortical bone-both of which have a low proton density (PD)-is sampled in a unique sequence setup. Additionally, the PD weighting of the ZTE sequence results in less contrast between soft tissues. Therefore, along with gray-scale inversion from black to white and vice versa, ZTE imaging provides excellent contrast between cortical bone and soft tissues similar to that of radiography and CT. However, despite isotropic or near-isotropic three-dimensional (3D) imaging capabilities of the ZTE sequence, spatial resolution in this technique is still inferior to that of radiography and CT, and 3D volume renderings are currently time-consuming and require postprocessing software that features segmentation and manual contouring. Optimization of ZTE MRI mostly entails adjustments of bandwidth, flip angle, field of view, and image matrix. A wide range of structural abnormalities and disease or healing processes in the musculoskeletal system are well delineated with ZTE MRI, including conditions that involve bone-based morphometric analyses (which aid diagnosis, help prognostication, and guide surgery), impaction, avulsion and stress fractures, loose bodies or erosions in and around joints, soft-tissue calcifications and ossifications, and bone tumors (including treatment response). The pitfalls of ZTE imaging include mimics of foci of calcification or ossification such as intra-articular gas and susceptibility artifacts from surgical materials and hemosiderin deposition, which can be avoided in many instances by cross-referencing images obtained with other MRI sequences. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Üstün Aydıngöz
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Adalet Elçin Yıldız
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - F Bilge Ergen
- From the Department of Radiology, Hacettepe University School of Medicine, 06230 Ankara, Turkey
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17
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Closed reduction and posterior percutaneous internal fixation for simple displaced talar neck fracture: a retrospective comparative study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2135-2143. [DOI: 10.1007/s00264-022-05432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
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18
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Smitaman EE, Davis M. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. Radiographics 2022; 42:661-682. [PMID: 35275783 DOI: 10.1148/rg.210167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hindfoot consists of the talus and calcaneus, spans the tibiotalar to transverse tarsal joints, and is critical for support of body weight and absorption and transfer of physiologic loads during bipedal movements. Hindfoot fractures account for approximately 17% of foot and ankle fractures, with calcaneal fractures being more common than talar fractures. Hindfoot fractures are usually caused by high-impact axial loads such as falls from heights and motor vehicle accidents, and understandably, they are often seen in patients with polytrauma. Long term, these fractures have implications in development of posttraumatic osteoarthrosis with associated pain and stiffness, affecting daily living activities. An overview of the talus and calcaneus is presented, with emphasis on fractures with articular involvement-namely, the tibiotalar and subtalar joints. Articular talar and calcaneal injuries can also alter hindfoot alignment, causing ankle and foot function abnormalities. Optimal treatment-that is, restoration of articular surfaces and hindfoot alignment followed by rigid fixation until fracture union-is dependent on an accurate understanding of the injury that is well depicted with imaging, radiography and CT in particular. The discussion of talar and calcaneal fractures includes a review of the normal anatomy, epidemiologic factors, classification systems, and imaging and pathologic-anatomic features of common injury patterns. This review is intended to aid surgical management and restoration of articular and hindfoot alignment for optimal ankle and foot function, thereby reducing patient morbidity in these often devastating injuries. ©RSNA, 2022.
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Affiliation(s)
- Edward Eddie Smitaman
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
| | - Michael Davis
- From the Department of Radiology, UCSD Health System, 408 Dickinson St, San Diego, CA 92103-8226 (E.S.); and Department of Radiology, UT Health Science Center, San Antonio, Tex (M.D.)
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19
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Hagen JE, Sands AK, Swords M, Rammelt S, Schmitz N, Richards G, Gueorguiev B, Souleiman F. Medial talar resection: how much remains stable? Eur J Trauma Emerg Surg 2022; 48:3961-3967. [PMID: 35199184 PMCID: PMC9532311 DOI: 10.1007/s00068-022-01915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
Purpose Pathologies of the medial talus (e.g., fractures, tarsal coalitions) can lead to symptomatic problems such as pain and nonunion. Bony resection may be a good solution for both. It is unclear how much of the medial talus can be taken before the subtalar joint becomes unstable. The aim of this study was to evaluate the effect a limited resection of the medial talar facet and the anteromedial portion of the posterior talar facet has on subtalar stability. Methods Eight fresh-frozen human cadaveric lower limbs were mounted in a frame for simulated weight-bearing. Computed tomography scans were obtained under 700 N single-legged stance loading, with the foot in neutral, 15° inversion, and 15° eversion positions. A sequential resection of 10, 20, and 30% of the medial facet and the anteromedial portion of the posterior talar facet to the calcaneus, based on the intact talus width, was performed. Measurements of subtalar vertical angulation, talar subluxation, coronal posterior facet angle and talocalcaneal (Kite) angle in the anteroposterior and lateral view were performed. Results Gross clinical instability was not observed in any of the specimens. No significant differences were detected in the measurements between the resected and intact states (P ≥ 0.10) as well as among the resected states (P ≥ 0.11). Conclusion In a biomechanical setting, resecting up to 30% of the medial facet and anteromedial portion of the posterior facet based on the intact talus width—does not result in any measurable instability of the subtalar joint in presence of intact ligamentous structures. Level of evidence V.
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Affiliation(s)
- Jennifer E Hagen
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopedics and Rehabilitation, Orthopedics University of Florida, Gainesville, FL, USA
| | - Andrew K Sands
- New York Presbyterian-Lower Manhattan Hospital, New York, NY, USA
| | | | - Stefan Rammelt
- Department of Foot and Ankle Surgery, University Hospital Dresden, Dresden, Germany
| | - Nina Schmitz
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | | | | | - Firas Souleiman
- AO Research Institute Davos, Davos, Switzerland. .,Department of Orthopedics, Trauma and Plastic Surgery, University Hospital of Leipzig, University of Leipzig, Leipzig, Germany.
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20
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Gorbachova T, Melenevsky YV, Latt LD, Weaver JS, Taljanovic MS. Imaging and Treatment of Posttraumatic Ankle and Hindfoot Osteoarthritis. J Clin Med 2021; 10:jcm10245848. [PMID: 34945144 PMCID: PMC8703616 DOI: 10.3390/jcm10245848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022] Open
Abstract
Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or result in instability of the joint. In addition to clinical evaluation, imaging plays a substantial role in the treatment planning of posttraumatic ankle and hindfoot osteoarthritis. Imaging evaluation must be tailored to specific clinical scenarios and includes weight bearing radiography that utilizes standard and specialty views, computed tomography which can be performed with a standard or a weight bearing technique, magnetic resonance imaging, and ultrasound evaluation. This review article aims to familiarize the reader with treatment rationale, to provide a brief review of surgical techniques and to illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis, such as joint-preserving procedures, ankle fusion, subtalar fusion, tibiotalarcalcaneal fusion and ankle arthroplasty. Preoperative findings will be discussed along with the expected postoperative appearance of various procedures in order to improve detection of their complications on imaging and to provide optimal patient care.
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Affiliation(s)
- Tetyana Gorbachova
- Einstein Medical Center, Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19141, USA
- Correspondence:
| | - Yulia V. Melenevsky
- Department of Radiology, UAB Medical Center, University of Alabama at Birmingham, Birmingham, AL 35249, USA;
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA;
| | - Jennifer S. Weaver
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Mihra S. Taljanovic
- Department of Radiology, University of New Mexico Health Sciences, Albuquerque, NM 87131, USA;
- Departments of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85724, USA
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21
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Osteochondral lesions of the talar dome: an up-to-date approach to multimodality imaging and surgical techniques. Skeletal Radiol 2021; 50:2151-2168. [PMID: 34129065 DOI: 10.1007/s00256-021-03823-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 02/02/2023]
Abstract
Osteochondral lesions (OCLs) of the talar dome consist of a multifactorial pathology of the articular cartilage and subchondral bone and can result in persistent ankle pain and osteoarthritis (OA). Along with a physical examination and clinical history, an imaging evaluation plays a pivotal role in the diagnosis of these lesions and is fundamental for making treatment decisions and determining prognosis by providing information regarding the size, location, and cartilage and subchondral bone statuses as well as associated lesions and degenerative changes. Multiple surgical techniques for OCLs of the talar dome have been developed in recent decades, including cartilage repair, regeneration, and replacement strategies, and radiologists should be acquainted with their specific expected and abnormal postoperative imaging findings to better monitor the results and predict poor outcomes. The present article proposes a thorough review of the ankle joint anatomy and biomechanics, physiopathology, diagnosis, and treatment of OCLs of the talar dome, highlighting the radiological approach and imaging findings in both pre- and postoperative scenarios.
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22
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Lambert LA, Mangwani J, Davies MB, Molloy AP, Mason LW. The lateral transligamentous approach to the talar dome. Foot Ankle Surg 2021; 27:767-771. [PMID: 33153917 DOI: 10.1016/j.fas.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/11/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated 43% talar body access with a single incision and without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach. METHODS The lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion. A mark was made on the talar dome where an instrument could be placed 90 degrees to the talar surface. The talus was subsequently disarticulated and high-resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid was documented using the mark made on the talar surface. ImageJ software was used to calculate the surface area exposed with each approach. RESULTS The mean percentage area of talar dome available through the transligamentous approach was 77.3% (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1, 2, 3, 5 & 6 with partial access to Zones 4, 8 & 9. CONCLUSION The lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zones 4,7 and 8, the posteromedial corner. LEVEL OF CLINICAL EVIDENCE V.
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Affiliation(s)
- Laura-Ann Lambert
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - Jitendra Mangwani
- Leicester Royal Infirmary, Leicester, United Kingdom; University of Leicester, Leicester, United Kingdom
| | - Mark B Davies
- Northern General Hospital, Sheffield, United Kingdom
| | - Andrew P Molloy
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon W Mason
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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23
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Abstract
BACKGROUND Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. METHODS This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. RESULTS All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. CONCLUSION Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Olivier Wijers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Jelle Posthuma
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands
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24
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Yang QD, Mu MD, Tao X, Tang KL. Three-dimensional printed talar prosthesis with biological function for giant cell tumor of the talus: A case report and review of the literature. World J Clin Cases 2021; 9:3147-3156. [PMID: 33969102 PMCID: PMC8080752 DOI: 10.12998/wjcc.v9.i13.3147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell tumors (GCT) are most commonly seen in the distal femur. These tumors are uncommon in the small bones of the hand and feet, and a very few cases have been reported. A giant cell tumor of the talus is rarely seen clinically and could be a challenge to physicians.
CASE SUMMARY We report a rare case of GCT of the talus in one patient who underwent a new reconstructive surgery technique using a three-dimensional (3D) printing talar prosthesis. The prosthesis shape was designed by tomographic image processing and segmentation using technology to match the intact side by mirror symmetry with 3D post-processing technologies. The patient recovered nearly full range of motion of the ankle after 6 mo. The visual analogue scale and American Orthopaedic Foot and Ankle Society scores were 1 and 89 points, respectively.
CONCLUSION We demonstrated that 3D printing of a talar prosthesis is a beneficial option for GCT of the talus.
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Affiliation(s)
- Qian-Dong Yang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Mi-Duo Mu
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Xu Tao
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Kang-Lai Tang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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25
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Sripanich Y, Dekeyser G, Steadman J, Rungprai C, Haller J, Saltzman CL, Barg A. Limitations of accessibility of the talar dome with different open surgical approaches. Knee Surg Sports Traumatol Arthrosc 2021; 29:1304-1317. [PMID: 32596777 DOI: 10.1007/s00167-020-06113-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE The aim of this study is to systematically review the current, relevant literature and provide a thorough understanding of the various open surgical approaches utilized to gain access to the talar dome for treatment of osteochondral lesions. Realizing the limits of access from soft tissue exposures and osteotomies, with and without external distraction, will help surgeons to select the appropriate approach for each individual clinical situation. METHODS A literature search was performed using three major medical databases: PubMed (MEDLINE), Scopus, and Embase. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodological quality of each included study. RESULTS Of 3108 reviewed articles, nine cadaveric studies (113 limbs from 83 cadavers) evaluating the accessibility of the talar dome were included in the final analysis. Most of these (7/9 studies) investigated talar dome access in the context of treating osteochondral lesions of the talus (OLTs) requiring perpendicular visualization of the involved region. Five surgical approaches (anteromedial; AM, anterolateral; AL, posteromedial; PM, posterolateral; PL, and direct posterior via an Achilles tendon splitting; DP), four types of osteotomy (anterolateral tibial, medial malleolar, distal fibular, and plafondplasty), and two methods of distraction (Hintermann retractor and external fixator) were used among the included studies. The most commonly used methods quantified talar access in the sagittal plane (6/9 studies, 66.7%). The greatest exposure of the talar dome can be achieved perpendicularly by performing an additional malleolar osteotomy (90.9% for lateral, and 100% for medial). The methodological quality of all included studies was determined to be satisfactory. CONCLUSION Gaining perpendicular access to the central portion of the talar dome, measured in the sagittal plane, has clear limitations via soft tissue approaches either medially or laterally from the anterior or posterior aspects of the ankle. It is possible to access a greater talar dome area in a non-perpendicular fashion, especially from the posterior soft tissue approach. Various types of osteotomies can provide greater accessibility to the talar dome. This systematic review can help surgeons to select the appropriate approach for treatment of OLTs in each individual patient preoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Graham Dekeyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Jesse Steadman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok, 10400, Thailand
| | - Justin Haller
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Rajagopal JR, Sahbaee P, Farhadi F, Solomon JB, Ramirez-Giraldo JC, Pritchard WF, Wood BJ, Jones EC, Samei E. A Clinically Driven Task-Based Comparison of Photon Counting and Conventional Energy Integrating CT for Soft Tissue, Vascular, and High-Resolution Tasks. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2020; 5:588-595. [PMID: 34250326 DOI: 10.1109/trpms.2020.3019954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Photon-counting CT detectors are the next step in advancing CT system development and will replace the current energy integrating detectors (EID) in CT systems in the near future. In this context, the performance of PCCT was compared to EID CT for three clinically relevant tasks: abdominal soft tissue imaging, where differentiating low contrast features is important; vascular imaging, where iodine detectability is critical; and, high-resolution skeletal and lung imaging. A multi-tiered phantom was imaged on an investigational clinical PCCT system (Siemens Healthineers) across different doses using three imaging modes: macro and ultra-high resolution (UHR) PCCT modes and EID CT. Images were reconstructed using filtered backprojection and soft tissue (B30f), vascular (B46f), or high-resolution (B70f; U70f for UHR) kernels. Noise power spectra, task transfer functions, and detectability index were evaluated. For a soft tissue task, PCCT modes showed comparable noise and resolution with improved contrast-to-noise ratio. For a vascular task, PCCT modes showed lower noise and improved iodine detectability. For a high resolution task, macro mode showed lower noise and comparable resolution while UHR mode showed higher noise but improved spatial resolution for both air and bone. PCCT offers competitive advantages to EID CT for clinical tasks.
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Affiliation(s)
- Jayasai R Rajagopal
- Carl E. Ravin Advanced Imaging Laboratories, and Medical Physics Graduate Program, Duke University, Durham, NC, 27705 USA
| | | | - Faraz Farhadi
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
| | - Justin B Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, and Department of Radiology, Duke University, Durham NC, 27705 USA
| | | | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda MD, 20892 USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, 20892 USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892 USA
| | - Ehsan Samei
- Carl. E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, and Departments of Electrical and Computer Engineering, Radiology, Biomedical Engineering, and Physics, Duke University, Durham, NC, 27705 USA
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Chaturvedi A, Mann L, Cain U, Chaturvedi A, Klionsky NB. Acute Fractures and Dislocations of the Ankle and Foot in Children. Radiographics 2020; 40:754-774. [PMID: 32243231 DOI: 10.1148/rg.2020190154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Distinct biologic and mechanical attributes of the pediatric skeleton translate into fracture patterns, complications, and treatment dilemmas that differ from those of adults. In children, increasing participation in competitive sports activities has led to an increased incidence of acute injuries that affect the foot and ankle. These injuries represent approximately 13% of all pediatric osseous injuries. Important posttraumatic complications include premature physeal arrest, three-dimensional deformities and consequent articular incongruity, compartment syndrome, and infection. The authors describe normal developmental phenomena and injury mechanisms of the ankle and foot and associated imaging findings; mimics and complications of acute fractures; and dislocations that affect the pediatric ankle and foot. Treatment strategies, whether conservative or surgical, are aimed at restoring articular congruency and functional alignment and, for pediatric patients specifically, protecting the physis. The different types of ankle and foot fractures are described, and the American College of Radiology guidelines used to determine appropriate imaging recommendations for patients who meet the Ottawa ankle and foot rules are discussed. The systems used to classify clinically important fractures, including the Salter-Harris, Dias-Tachdjian, Rapariz, and Hawkins systems, are described, with illustrations that reinforce key concepts. These classification systems aid in diagnosis and treatment planning, facilitate communication, and help standardize documentation and research. This information is intended to supplement radiologists' understanding of developmental phenomena, anatomic variants, fracture patterns, and associated complications that affect the pediatric foot and ankle. In addition, the role of imaging in ensuring appropriate treatment, follow-up, and patient and parent counseling is highlighted. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Apeksha Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Laura Mann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Usa Cain
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
| | - Nina B Klionsky
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642
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28
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Talus Partitus: a review of five cases diagnosed by MRI. Skeletal Radiol 2020; 49:491-501. [PMID: 31707422 DOI: 10.1007/s00256-019-03329-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Talus partitus is a rare skeletal developmental abnormality characterized by a split of the posterior talar bone in the coronal plane. Patients with talus partitus typically present with posterior ankle pain and instability, often displaying varying degrees of chondrosis and secondary degenerative change on imaging. To date, only few case reports describing the imaging appearance of talus partitus have been published. The majority of these publications are limited to radiographic and computed tomography (CT) imaging findings, despite the ubiquity of magnetic resonance imaging (MRI). To the authors' knowledge, there is little description of typical MRI findings of the symptomatic talus partitus in the radiologic literature. We present a series of five cases of talus partitus identified on MRI and examine pitfalls in diagnosis, differential considerations, pathophysiology, and treatment options.
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Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the Talus: Current Concepts. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419900766. [PMID: 35097362 PMCID: PMC8697161 DOI: 10.1177/2473011419900766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Talus fractures continue to represent a challenging and commonly encountered group of injuries. Its near-complete articular cartilage surface, and its role in force transmission between the leg and foot, makes successful treatment of such injuries a mandatory prerequisite to regained function. Familiarity with the complex bony, vascular, and neurologic anatomy is crucial for understanding diagnostic findings, treatment indications, and surgical techniques to maximize the likelihood of anatomic bony union. This review details the structure and function of the talus, a proper diagnostic workup, the treatment algorithm, and post-treatment course in the management of talus fractures.
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Affiliation(s)
- Andrew M Schwartz
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - William O Runge
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | - Jason T Bariteau
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
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Wijers O, Engelmann EW, Posthuma JJ, Halm JA, Schepers T. Functional Outcome and Quality of Life After Nonoperative Treatment of Posterior Process Fractures of the Talus. Foot Ankle Int 2019; 40:1403-1407. [PMID: 31441314 PMCID: PMC6900211 DOI: 10.1177/1071100719868712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fractures of the posterior process of the talus are frequently overlooked, possibly leading to nonunion, arthritis, and chronic pain. Given the rare occurrence, previous case series have been small and without functional outcome scores. Therefore, we aimed to provide evidence on outcomes after nonoperative and operative management of posterior process fractures of the talus. METHODS All patients treated at a level 1 trauma center between 2012 and 2018 were retrospectively evaluated. Patient, fracture, and treatment characteristics were collected, and functional outcome as well as quality of life were assessed. Twenty-nine patients with posterior process fractures of the talus were identified in our database. RESULTS The most frequently seen mechanism of trauma was fall from height in 13 patients (44.8%). Twenty-two patients underwent primary arthrodesis or operative reduction and fixation of the fracture (75.9%). Eighty-two percent of the patients returned the questionnaires with a mean follow-up of 6 years. The 2 patients with primary arthrodesis were excluded from outcome analysis. The mean Foot Function Index score was 1.8 (range 0.0-10). The mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 78.7 points (range 0-100). The mean quality of life EuroQol-5D (EQ-5D) index score was 0.78 (range -0.26 to 1). The mean visual analog scale (VAS) on overall patient satisfaction was 8.2 (range 1-10). CONCLUSION Operative management of extended posterior talar fractures was found to provide good functional outcome, quality of life, and patient satisfaction. Although the patients treated nonoperatively were found to have less severe injuries, they demonstrated worse overall outcome, which is supportive of surgical management. Nonoperative treatment is therefore only justified in selected patients. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Olivier Wijers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Esmee W.M. Engelmann
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Jelle J. Posthuma
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Jens A. Halm
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
- Tim Schepers, MD, PhD, Trauma Unit, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
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A rare combination of closed fracture of right talar body Sneppen 2 with associated medial malleolus: A case report. Int J Surg Case Rep 2019; 65:20-26. [PMID: 31678695 PMCID: PMC6838554 DOI: 10.1016/j.ijscr.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Talar fractures are uncommon. Anatomic and stable reduction of talar fractures is of paramount importance. ORIF plate screw and ORIF TBW can be used to treat talar fracture. Good prognosis can be achieved by ORIF plate screw and ORIF TBW. Introduction Ankle fractures are common, with the incidence of up to 174 cases per 100,000 adults per year. The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The combination of talar body fracture in sagittal plane along with medial malleolus fracture is an unusual pattern of injury and rarely reported in the literature. Presentation of case We presented a case of nineteen-year old male with pain on the right ankle as a result from motorcycle accident twelve hours before admitted to Cipto Mangunkusumo Hospital. After the patient underwent close reduction and immobilization using back slab, patient then underwent open reduction surgery of the right ankle then fixated using plate and screw combined by tension band wiring (TBW) at the right medial malleolus. Discussion Talar and Medial malleolus fracture was initially evaluated by physical examination and radiographic imaging and classified by Sneppen classification. After the diagnosis was established the patient underwent ORIF plate, screw and tension band wiring. In post-operative x-ray examination, there was a significant improvement in talocrural angle and medial clear space but same result in tibiofibular overlap and tibiofibular. Conclusion Open reduction and internal fixation (ORIF) plate and screw combined by tension band wiring (TBW) is the right surgical treatment for patient with closed fracture of right talar body Sneppen 2 with associated medial malleolus fracture. The outcome of the treatment is excellent because the patient presented was able to fully recover to normal activity.
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Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:701-719. [PMID: 31575401 DOI: 10.1016/j.mric.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
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Hierro-Cañas F, Andrés-Cano P, Rabadán-Márquez G, Giráldez-Sánchez M, Cano-Luis P. Talus fractures. Functional results for polytraumatized patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Biz C, Golin N, De Cicco M, Maschio N, Fantoni I, Frizziero A, Belluzzi E, Ruggieri P. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management. BMC Musculoskelet Disord 2019; 20:363. [PMID: 31391024 PMCID: PMC6686493 DOI: 10.1186/s12891-019-2738-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The main purpose of this retrospective case series study was to evaluate long-term radiographic and clinical outcomes of a consecutive series of patients diagnosed with isolated, displaced, closed talar neck or body fractures treated by open reduction and internal fixation (ORIF). Secondly, the aim was to verify the influence of the location of talar fractures on the outcomes, the prognostic value of the Hawkins sign, whether operative delays promote avascular necrosis (AVN) and if the fractures require emergent surgical management. METHODS From January 2007 to December 2012, at our institution, 31 patients underwent ORIF through the use of screws. On the basis of Inokuchi criteria, the injuries were divided between neck and body fractures, which were classified according to Hawkins and Sneppen, respectively. The patients included were divided into two groups in relation to fracture location and complexity. Radiographic assessment focused on reduction quality, bone healing, the Hawkins sign and post-traumatic arthritis (PTA) development. For the clinical evaluation, clinical-functional scores (AOFAS Ankle-Hindfoot Score; MFS; FFI-17; SF-36) and VAS were determined, and statistical analysis was performed. RESULTS 27 patients, 19 males and 8 females, mean age 38.3 years, were included with an average follow-up period of 83.2 months (range 49-119). There were 9 neck and 19 body fractures; their reduction was anatomical or nearly anatomical in 22 cases, and all reached radiographic consolidation after a mean period of 3.4 months (range 1.7-7). The Hawkins sign was observed in 9 cases, in which necrosis did not develop. With a 0-11 day surgical timing interval, more than 60% of the patients obtained good or fair results with different scores, while 18 (66.7%) were completely satisfied (VAS: 9-10). The early complications included malunions (21.4%) and wound problems (25%); the late complications involved AVN (25%) and PTA (78.6%). CONCLUSIONS Despite a high rate of long-term complications, satisfactory clinical results were achieved. Talar fracture location did not influence the outcomes, the Hawkins sign was confirmed as a positive prognostic factor, and operation timing did not influence AVN development. Hence, these injuries do not require emergent surgical management by ORIF.
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Affiliation(s)
- Carlo Biz
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Nicolò Golin
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Michele De Cicco
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Nicola Maschio
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Ilaria Fantoni
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Elisa Belluzzi
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy.,Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic and Traumatology Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, via Giustiniani 2, 35128, Padova, Italy
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Os Conundrum: Identifying Symptomatic Sesamoids and Accessory Ossicles of the Foot. AJR Am J Roentgenol 2019; 213:417-426. [DOI: 10.2214/ajr.18.20761] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
CLINICAL/METHODICAL ISSUE Due to mechanical loading and the number of joints involved, fractures of the foot are among the most common fractures. STANDARD RADIOLOGICAL METHODS X-ray is basis for diagnostic workup of all foot fractures. METHODICAL INNOVATIONS For stress fractures, the additional use of magnetic resonance imaging (MRI) is indicated. Computed tomography (CT) can be used for preoperative imaging of intraarticular tarsal fractures. PERFORMANCE Simple traumatic fractures can be reliably diagnosed by X‑ray. On the other hand, there is a poor sensitivity for stress fractures. ACHIEVEMENTS Using a combination of X‑ray, MRI, and CT, it is possible to reliably diagnosis and classify foot fractures. PRACTICAL RECOMMENDATIONS The first step to diagnose a foot fracture should be the X‑ray. CT and MRI can also be used to detect intra-articular fractures and MRI can be used for stress fractures.
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Hierro-Cañas FJ, Andrés-Cano P, Rabadán-Márquez G, Giráldez-Sánchez MA, Cano-Luis P. Talus fractures. Functional results for polytraumatized patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:336-341. [PMID: 31078442 DOI: 10.1016/j.recot.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/31/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Talar fractures are uncommon lesions (0.1-0.9%) and have a high rate of complications. One of the situations in which a fracture of the talus can occur is in the context of polytrauma which may further compromise the functional prognosis. The aim of this study was to analyze the functional results in patients with talar fractures whether or not they occurred in the context of polytrauma. Observational study on a retrospective cohort of 24 patients operated in our centre (2008-2016). They were grouped according to whether they were polytraumatized (ISS>16) or not (ISS≤16). Review of sociodemographic, radiographic, functional variables (VAS pain scale and FADI -Foot and Ankle Disability Index-) and the onset of complications such as arthrosis, arthrodesis or avascular necrosis. Review of 25 talar fractures in 24 patients with a mean age of 38 years (19-75) and a mean follow-up of 4.2 years (0.5-9). According to the ISS, 44% of patients (11) were polytraumatized and 56% (14) were not. The average score according to the FADI scale was 62 points for the polytraumatized patients and 76.9 for the non-polytraumatized patients. The pain according to the VAS scale was 5.8 points in the group of polytraumatized patients and 4.3 in the non-polytraumatized patient group. Regarding complications, 64% of the polytraumatized patients and 43% of the non-traumatized patients had a complication. 36% of the polytraumatized patients had clinical and radiological signs of subtalar arthrosis compared to 35% of the non-traumatized patients, of whom 27% underwent arthrodesis compared to 28% of the non-traumatized patients. 27% of the polytraumatized patients were diagnosed with avascular necrosis as opposed to 0% of the non-polytraumatized patients.
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Affiliation(s)
- F J Hierro-Cañas
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - P Andrés-Cano
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - G Rabadán-Márquez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - M A Giráldez-Sánchez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Cano-Luis
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Fadl SA, Sandstrom CK. Pattern Recognition: A Mechanism-based Approach to Injury Detection after Motor Vehicle Collisions. Radiographics 2019; 39:857-876. [PMID: 31059399 DOI: 10.1148/rg.2019180063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Motor vehicle collisions cause substantial mortality, morbidity, and expense worldwide. Certain types of injuries are more likely to result from frontal versus side-impact collisions, and knowledge of these specific patterns and why they occur aids in accurate and efficient diagnosis of traumatic injuries. Although the proper use of seat belts decreases crash-related mortality during frontal impact, certain injury patterns to the torso are directly attributed to restraint use. The spectrum of seat belt-related injuries ranges from mild skin and soft-tissue contusions to traumatic bowel injuries and unstable spine injuries that require surgery. Impact with the steering wheel or windshield during a frontal crash can cause characteristic injuries to the head, neck, torso, and distal upper extremity. Steering wheel deformity is an independent predictor of serious thoracic and abdominal injury among front-seat passengers. Impact of a flexed knee with the dashboard during a frontal collision can cause knee, thigh, and hip injuries. Distal lower extremity injuries are encountered frequently when the floorboard is driven into the foot. Lateral impact crashes often result in traumatic brain, thoracic, abdominal, and pelvic injuries, which are more often fatal to occupants on the side of the impact. The specific mechanism-based injury patterns are reviewed to establish a structured systematic search pattern that enables the radiologist to identify traumatic injuries with greater accuracy and speed, thereby improving the care of patients who experience acute trauma. ©RSNA, 2019 See discussion on this article by Ballard and Mellnick .
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Affiliation(s)
- Shaimaa A Fadl
- From the Department of Radiology, University of Washington Medical Center, Box 359728, 325 Ninth Ave, Harborview Medical Center, Seattle, WA 98104-2499
| | - Claire K Sandstrom
- From the Department of Radiology, University of Washington Medical Center, Box 359728, 325 Ninth Ave, Harborview Medical Center, Seattle, WA 98104-2499
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Ortiz-Cruz JR, Ojeda Boscana IL. Talar Extrusion, A Very Rare Sequela of Trauma: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:575-579. [PMID: 31011148 PMCID: PMC6489417 DOI: 10.12659/ajcr.913576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Patient: Female, 38 Final Diagnosis: Talar extrusion Symptoms: Acute right ankle posttraumatic injury Medication: — Clinical Procedure: Tibiocalcaneal arthrodesis placement Specialty: Radiology
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Affiliation(s)
- Joaquin R Ortiz-Cruz
- Department of Diagnostic Radiology, University of Puerto Rico, San Juan, Puerto Rico
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Sukerkar PA, Fast AM, Riley G. Extreme Sports Injuries to the Pelvis and Lower Extremity. Radiol Clin North Am 2018; 56:1013-1033. [PMID: 30322484 DOI: 10.1016/j.rcl.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Extreme sports are growing in popularity, and physicians are becoming increasingly aware of injuries related to these activities. Imaging plays a key role in diagnosing and determining clinical management of many of these injuries. This article describes general imaging techniques and findings in various injuries specific to multiple extreme sports.
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Affiliation(s)
- Preeti Arun Sukerkar
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Angela M Fast
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Geoffrey Riley
- Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Hood CR, Miller JR, Hollinger JK. Defining Talar Head and Neck Pathology: The Malvern Classification System. J Foot Ankle Surg 2018; 57:131-139. [PMID: 28843549 DOI: 10.1053/j.jfas.2017.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Indexed: 02/03/2023]
Abstract
Talar fractures account for <1% of all fractures in the body and 3% to 6% of pedal fractures. Of these fractures, avulsion and neck fractures represent the most and second most common type, respectively. Several classification systems exist for talar fractures of the talar dome (Berndt-Hardy), talar neck dislocation (Hawkins), and talar body (Sneppen) anatomic locations. Although diverse, they are not all encompassing for fracture patterns of the talus. Another set of pathologic issues occur about the talar head and neck region that can be seen in the clinical setting. Thus, a new classification system (Malvern classification system for talar head/neck fractures) was devised and defined for this location. The system represents a comprehensive review of the available published data and synthesis into an organized classification system.
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Affiliation(s)
- Christopher Robin Hood
- Fellowship-Trained Foot and Ankle Surgeon, Premier Orthopaedics and Sports Medicine, Malvern, PA.
| | - Jason Roy Miller
- Fellowship Director, Department of Foot and Ankle Surgery, Premier Orthopaedics and Sports Medicine, Malvern, PA; Residency Director, Podiatric Medicine and Surgery Residency/Reconstructive Rearfoot Ankle Surgery, Phoenixville Hospital, Phoenixville, PA
| | - Josuha Kevin Hollinger
- Fellow, Pennsylvania Intensive Lower Extremity Fellowship, Premier Orthopaedics and Sports Medicine, Malvern, PA
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Caracchini G, Pietragalla M, De Renzis A, Galluzzo M, Carbone M, Zappia M, Russo A, Greco F, Miele V. Talar fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:151-165. [PMID: 29350644 PMCID: PMC6179081 DOI: 10.23750/abm.v89i1-s.7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The talus is the second largest bone of the foot. It is fundamental to ensure normal ankle-foot movements as it connects the leg and the foot. Talar fractures are usually due to high energy traumas (road accidents, high level falls). They are not common as they account for 3-5% of ankle and foot fractures and 0.85% of all body fractures. However, talar fractures not correctly diagnosed and treated can lead to avascular necrosis of the astragalus, pseudoarthrosis, early osteoarthrisis and ankle instability, declining the quality of life of patients. METHODS A PubMed search was performed using the terms "talus" "talus AND radiology", "talar fractures", and "talar fractures classification", selecting articles published in the last 98 years. We selected articles about pre-treatment and post-surgery talar fractures diagnostic imaging. We also selected articles about talar fractures complications and traumatic talar dislocations. Case reports have not been included. AIM OF THE WORK to describe radiological evaluations, classification systems, and biomechanical patterns involved in talar fractures. Also we will briefly describe talar fractures complications and treatment option and strategies. CONCLUSIONS This work suggests a radiological approach aimed to classify talar fractures and guide treatment strategies, improving patient outcomes.
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Jentzsch T, Hasler A, Renner N, Peterhans M, Sutter R, Espinosa N, Wirth SH. The V sign in lateral talar process fractures: an experimental study using a foot and ankle model. BMC Musculoskelet Disord 2017; 18:284. [PMID: 28673281 PMCID: PMC5496392 DOI: 10.1186/s12891-017-1642-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/27/2017] [Indexed: 11/29/2022] Open
Abstract
Background Lateral talar process fractures (LTPF) are often missed on conventional radiographs. A positive V sign is an interruption of the contour of the LTP. It has been suggested, but not proven to be pathognomonic for LTPF. The objective was to study whether the V sign is pathognomonic for LTPF and if it can be properly assessed in different ankle positions and varying fracture types. Methods An experimental study was conducted. Two investigators assessed lateral radiographs (n = 108) of a foot and ankle model. The exposure variables were different ankle positions and fracture types. The primary outcome was the correct detection of a V sign. The secondary outcomes were the detection of the V sign depending on ankle position and fracture type as well as the uncertainty. Results The interobserver agreement on the V sign and type of fracture were fair (κ = 0.35, 95% CI 0.18–0.53, p < 0.001 and κ = 0.37, 95% CI 0.26–0.48, p < 0.001). The mean sensitivity, specificity, PPV, NPV, and likelihood ratio for the detection of the V sign were 77% (95% CI 67–86%), 59% (95% CI 39–78%), 85% (95% CI 75–92%), 46% (95% CI 29–63%), and 2. The mean uncertainty in the V sign detection was 38%. The V sign identification stratified by ankle position and fracture type showed significant better results with increasing inversion (p = 0.035 and p = 0.011) and type B fractures (p = 0.001 and p = 0.013). Conclusions The V sign may not be pathognomonic and is not recommended as the only modality for the detection of LTPF. It is better visualized with inversion, but does not depend on plantar flexion or internal rotation. It is also better seen in type B fractures. It is difficult to detect and investigator-dependent. It may be helpful in a clinical setting to point into a direction, but a CT scan may be used if in doubt about a LTPF.
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Affiliation(s)
- Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Niklas Renner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Manuel Peterhans
- Department of Orthopaedics, Kantonsspital Aarau, Aarau, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Core curriculum case illustration: medial peritalar dislocation. Emerg Radiol 2017; 25:329-330. [PMID: 28389706 DOI: 10.1007/s10140-017-1499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Abstract
This is the 29th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.htm .
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