Background The talus is the second largest tarsal bone and makes the osseous link between the leg and foot region. The branches of the dorsalis pedis, posterior tibial, and peroneal arteries enter vascular foramina (VF) on the various surfaces of the talus and provide intraosseous blood supply. Understanding the morphology and morphometry of VF might be helpful in reducing the risk of vascular injury associated with surgical interventions to the talus.  Aim and objectives The purpose of this study is to contribute reference data for the morphology of VF of talus in a sample from Türkiye. Materials and methods This study was performed on 62 dry talus samples from Türkiye. The number, location, size, and foraminal index of the VF were evaluated on each talus. The total and medial surface lengths, distances of the closest and furthest foramina on the inferior surface, and distances of the closest and furthest foramina on medial surface were measured. Results No VF was detected on articular surfaces and the head of the talus. The majority of VF (1754; 81.17%) were detected on the neck, and 708 (40.36%) were located on the inferior surface of the neck. On the body, VF was mostly detected on the medial surface (233; 57.25%). The mean foraminal indices of the closest and furthest foramina on the inferior surface were 38.85% and 77.89%, respectively. The mean foraminal index of the closest foramina on the medial surface was 33.52%, and the furthest foramina on the medial surface was 63.91%. The total number of VF on 62 tali was determined as 2161. The majority (1521; 70.38%) of the size of VF was ≥0.6 mm. The mean total length was 55.14±4.69 mm, and the medial surface length was 49.18±4.18 mm. Conclusion Knowing the morphologic and morphometric properties of the VF gains importance during surgical interventions to the talus to reduce vascular damage. According to our results, lateral approaches to the talus may be safer than other approaches. To our knowledge, there is no study about the morphology of VF of the talus in Türkiye samples. We believe that the results of this study will provide reference data for morphology and morphometry of VF of talus.

BACKGROUND: Talar neck fractures are rare but potentially devastating injuries, with early reduction and rigid fixation essential to facilitate union and prevent avascular necrosis. Even small degrees of malunion will alter load transmission and subtalar joint kinematics. Changes in fixation techniques have led to dual plating strategies. While locked plating has perceived advantages in porotic bone and comminution, its biomechanical benefits in talar neck fractures have not been shown.
OBJECTIVE: To compare the strength of locking vs. non-locking plate fixation in comminuted talar neck fractures.
METHODS: Seven pairs of cadaveric tali were randomised to locking or non-locking plate fixation. A standardised model of talar neck fracture with medial comminution was created, and fixation performed. The fixed specimens were mounted onto a motorised testing device, and an axial load applied.
RESULTS: Peak load to failure, deformation at failure, work done to achieve failure, and stiffness of the constructs were measured. No statistically significant difference was found between locking and non-locking constructs for all parameters.
CONCLUSIONS: Both constructs provide similar strength to failure in talar neck fracture fixations. Mean peak load to failure did not exceed the theoretical maximum forces generated of 1.1 kN when weight-bearing. We would advocate caution with early mobilisation in both fixations.

UNASSIGNED: Joint salvage surgeries such as tibiotalocalcaneal arthrodesis and talar prosthesis are commonly used in the surgical treatment of collapsed avascular necrosis of the talus (AVNT). However, differences in outcomes of these 2 surgical treatments are still inconclusive. This study compared the 10- to 13-year outcomes and 10-year survivorship rates of tibiotalocalcaneal arthrodesis and talar body prosthesis in the surgical treatment of collapsed AVNT.
UNASSIGNED: A retrospective comparative study was conducted of patients who underwent either tibiotalocalcaneal arthrodesis or talar body prosthesis implantation between 2005 and 2012. The demographic matching process resulted in 24 patients per treatment group. Clinical outcomes were evaluated using a numeric rating scale (NRS) of 2 hours of activities of daily living (ADL) and Foot and Ankle Ability Measure (FAAM) for ADL. Radiographic assessments included the incidence of nonunion, adjacent joint arthritis, and prosthesis loosening. The 10-year survivorship of both surgical treatments was calculated. A P value of less than .05 was considered statistically significant.
UNASSIGNED: The median NRS of 2 hours of ADL and FAAM score for ADL were statistically significantly better in the talar body prosthesis group, with P values of .001 and <.001, respectively. The statistically significant differences in FAAM score for ADL exceeded the minimum clinically important difference. In the tibiotalocalcaneal arthrodesis group, nonunion was observed in 7 of 24 patients (29.2%). No prosthesis loosening was reported in the talar body prosthesis group. The 10-year survivorship was statistically significantly higher in talar body prosthesis than tibiotalocalcaneal arthrodesis (95.8% vs 70.8%), P = .023.
UNASSIGNED: Talar body prosthesis implantation in selected eligible patients demonstrated statistically significantly better 10- to 13-year clinical outcomes and higher 10-year survivorship compared with tibiotalocalcaneal arthrodesis in the surgical treatment of collapsed AVNT.
UNASSIGNED: Level III, retrospective cohort comparative study.

UNASSIGNED: Isolated subtalar joint dislocations without associated fractures are rare in the medical literature. They occur when the talus bone remains in place while the calcaneus and navicular bones shift out of place. These dislocations account for about 15% of talus bone injuries and 1 to 2% of all joint dislocations. They are more common in young men following inversion trauma.
UNASSIGNED: This study aims to improve the understanding of diagnosis, treatment, and management of these rare injuries for better patient care.
UNASSIGNED: 17-year-old male patient with type 1 diabetes mellitus presented to the emergency department with severe ankle pain and swelling following an inversion injury, which rendered him unable to walk or stand. Despite his chronic condition, he was hemodynamically stable, with no neurovascular deficits but an apparent deformity in the left ankle. Treatment involved pain management with morphine, successful closed reduction under ketamine sedation, and immobilization. Follow-up radiographs and a CT scan revealed no fractures but indicated soft tissue edema, joint effusion, and subsequent osteopenia. At a three-month follow-up, the patient experienced ongoing pain and weight-bearing difficulties, diagnosed as complicated pain syndrome requiring further physiotherapy and rehabilitation.
UNASSIGNED: This case highlights the clinical challenges and complications in managing isolated subtalar joint dislocations, particularly in patients with systemic health issues, and contributes valuable insights to the sparse literature on this topic.

UNASSIGNED: Talar displacement is considered the main predictive factor for poor outcomes and the development of post-traumatic osteoarthritis after ankle fractures. Isolated lateral talar translation, as previously studied by Ramsey and Hamilton using carbon powder imprinting, does not fully replicate the multidirectional joint subluxations seen in ankle fractures. The purpose of this study was to analyze the influence of multiple uniplanar talar displacements on tibiotalar contact mechanics utilizing weightbearing computed tomography (WBCT) and finite element analysis (FEA).
UNASSIGNED: Nineteen subjects (mean age = 37.6 years) with no history of ankle surgery or injury having undergone WBCT arthrogram (n = 1) and WBCT without arthrogram (n = 18) were included. Segmentation of the WBCT images into 3D simulated models of bone and cartilage was performed. Three-dimensional (3D) multiple uniplanar talar displacements were simulated to investigate the respective influence of various uniaxial displacements (including lateral translation, anteroposterior translation, varus-valgus angulation, and external rotation) on the tibiotalar contact mechanics using FEA. Tibiotalar peak contact stress and contact area were modeled for each displacement and its gradations.
UNASSIGNED: Our modeling demonstrated that peak contact stress of the talus and tibia increased, whereas contact area decreased, with incremental displacement in all tested directions. Contact stress maps of the talus and tibia were computed for each displacement demonstrating unique patterns of pressure derangement. One millimeter of lateral translation resulted in 14% increase of peak talar contact pressure and a 3% decrease in contact area.
UNASSIGNED: Our model predicted that with lateral talar translation, there is less noticeable change in tibiotalar contact area compared with prior studies whereas external rotation greater than 12 degrees had the largest effect on peak contact stress predictions.
UNASSIGNED: Level V, computational simulation study.

When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI.
Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated.
Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior.
The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this.
Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.

OBJECTIVE: To investigate the clinical effect of the anteromedial cannulated screw approach in the treatment of Hawkins II/III talus fractures in children.
METHODS: A retrospective study was conducted on 20 children with talar fractures admitted to Renmin Hospital from September 2018 to February 2022. The fracture healing and functional recovery of the affected limb were strictly followed up after the operation. There were 14 males and 6 females. The average age was 9 years (range 6-12 years). According to the Hawkins classification, there were 12 cases of talar neck fracture type II and 8 cases of type III. All patients were fixed with cannulated compression screws via an anteromedial approach. According to the American Orthopedic Foot and Ankle Society ankle and hindfoot function scoring system, limb function was evaluated before and after the operation. A visual analog scale was used to evaluate the degree of postoperative pain.
RESULTS: All 20 children were followed up for 12 months to 30 months, with an average of 15 months. We found that there was no significant difference in the excellent and good rate (76.9%) and necrosis rate (30.8%) between male children and female children (71.4%) and necrosis rate (28.6%) (P > 0.05). The excellent and good rates (92.9%) of children younger than 9 years old at the time of injury were higher than those of children older than 9 years old (33.3%), and the incidence of avascular necrosis of the talus was lower. The differences between the two groups were statistically significant (P < 0.05). The average prognosis score of children who underwent surgery within 5 days after injury was 89.2 ± 6.4, which was significantly higher than that of children who underwent surgery after 5 days (72.9 ± 13.1), and the difference was statistically significant (P < 0.05). There was no significant difference between patients who underwent surgery within 5 days after injury (15.4%) and those who underwent surgery after 5 days (51.7%) (P > 0.05). The excellent and good rates of talar neck fracture type II and talar neck fracture type III were 90.1% and 55.6%, respectively.
CONCLUSIONS: The anteromedial approach combined with cannulated compression screws for the treatment of Hawkins II/III talus fractures in children not only has a clear surgical field, but the fracture can also be reduced and fixed under direct vision using this technique. It does not affect the stability of the ankle joint and is conducive to the recovery of ankle function. It can be used as a surgical scheme for the treatment of talar fractures in children.

UNASSIGNED: Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm2. However, some patients have persistent pain and limitation of movement in the early postoperative period. No studies have investigated the combined treatment of microfracture and shortwave treatment in these patients. The aim of this prospective single-centre, randomized, double-blind, placebo-controlled trial was to compare the outcome in patients treated with arthroscopic microfracture combined with radial extracorporeal shockwave therapy (rESWT) and arthroscopic microfracture alone, in patients with ostechondritis of the talus.
UNASSIGNED: Patients were randomly enrolled into two groups. At three weeks postoperatively, the rESWT group was given shockwave treatment, once every other day, for five treatments. In the control group the head of the device which delivered the treatment had no energy output. The two groups were evaluated before surgery and at six weeks and three, six and 12 months postoperatively. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Secondary outcome measures included a visual analogue scale (VAS) score for pain and the area of bone marrow oedema of the talus as identified on sagittal fat suppression sequence MRI scans.
UNASSIGNED: A total of 40 patients were enrolled and randomly divided into the two groups, with 20 in each. There was no statistically significant difference in the baseline characteristics of the groups. No complications, such as wound infection or neurovascular injury, were found during follow-up of 12 months. The mean AOFAS scores in the rESWT group were significantly higher than those in the control group at three, six, and 12 months postoperatively (p < 0.05). The mean VAS pain scores in the rESWT group were also significantly lower than those in the control group at these times (p < 0.05). The mean area of bone marrow oedema in the rESWT group was significantly smaller at six and 12 months than in the control group at these times (p < 0.05).
UNASSIGNED: Local shockwave therapy was safe and effective in patients with osteochondiritis of the talus who were treated with a combination of arthroscopic surgery and rESWT. Preliminary results showed that, compared with arthroscopic microfracture alone, those treated with arthroscopic microfracture combined with rESWT had better relief of pain at three months postoperatively and improved weightbearing and motor function of the ankle.

OBJECTIVE: This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid (PGA-HA)-based cell-free scaffold (CFS) in Bristol Stage 4 and Stage 5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm2 .
METHODS: Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8±2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n=23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging (MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system.
RESULTS: The mean follow-up was 36.2±5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71±4.44 points to the postoperative of 86.00±6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28±7.91 points to 95.42±4.41 points in Group 2 at 12-month follow-up (p=0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5±2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p=0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r=0.347, p<0.001).
CONCLUSIONS: Arthroscopic AMIC procedure in deep OLTs between 1.5 cm2 and 3 cm2 can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.

BACKGROUND: Osteochondral lesions of the talar dome (OLTD) are most often found in patients for whom the return to sports activities is the main issue. Two types of surgery have been distinguished at present, bone marrow stimulation techniques and mosaicplasty techniques. The size of the lesion indicating the need for bone marrow stimulation as the required surgical procedure has recently been decreased (<1cm). The main objective of this study was therefore to evaluate the return to sport after OLTD surgery. Our hypothesis is that surgery of osteochondral lesions of the talar dome allows the resumption of sports activities in the majority of cases.
METHODS: This multicenter prospective study was conducted across 10 French centers specializing in foot and ankle surgery. All patients aged 18 to 65 with symptomatic OLTD resistant to thorough medical treatment for at least 6 months, justifying surgery, were included from June 2018 to September 2019. In addition to the usual demographic data, the practice of sport and level (professional, competitive, leisure) were systematically investigated preoperatively. A common protocol for surgical management and postoperative follow-up had previously been established according to the arthrographic stage of the lesion. The most recent recommendations based on size, but also depth, were taken into account. The primary endpoint was return to sport.
RESULTS: A final functional evaluation with the AOFAS (American Orthopedic Foot & Ankle Society) score was performed at a minimum of 12 months. Of 58 sports patients, 70.6% returned to sport (41/58) with an average delay of 4.3 months. A high AOFAS functional score (p=0.02) and a stage 1 lesion (p=0.006) were the only preoperative criteria significantly associated with a return to sport. No other factor was predictive of a return to sport.
CONCLUSIONS: Our prospective study shows that 70.6% of sports patients returned to sport after OLTD surgery according to a surgical protocol and standardized follow-up.
METHODS: II.