Management and classification of the fracture of lateral process of talus:An overview and literature update

Fracture of the lateral process of the talus(FLPT)is uncommon in clinical practice and can be easily missed or misdiagnosed.In recent years,as researchers from all over the world have further deepened their research on FLPT,there has been a breakthrough in the classification,and the methods and principles of clinical management have changed accordingly;however,there is still no standardized guideline for the diagnosis and management of FLPT,and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years.In this article,we review the clinical classification,classification-based therapeutic recommendations,and prognosis of FLPT,with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.

A bibliometric analysis and visualization of osteochondral lesions of talus (2004-2021)

Background:Osteochondral lesions of the talus(OLTs)are a significant challenge for foot and ankle specialists,which could cause pain and decrease patient function.Researchers can use the findings of this study to shape future directions for research by exploring global trends and hotspots in OLT.Methods:Web of Science Core Collection was used to retrieve literature related to OLT between 2004 and 2021.This report covers the current state of OLTs,such as publications,journals,trends,hotspots,and the performances of relevant countries,institutions and authors.The co-citation analysis,the coauthorship analysis,the cooccurrence analysis,and the bibliographic coupling analysis were conducted with the Bibliometrix R package,VOSviewer v1.6.10.0,and CiteSpace 5.8.R3.Results:During an 18-year review,717 articles and 76 review articles on OLT published from 2004 to 2021 were reviewed.The USA has made the largest contribution to the OLT-related literature,and a significant contribution has been made by Kennedy JG(48/6.05%)and van Dijk CN(30/3.78%).In terms of total link strength,Foot&Ankle International was the leading journal.Analysis showed that the global research hotspots of OLTs focused on the pathogenesis,diagnosis,clinical research,and surgical treatment of OLT.It would be significant to pay close attention to future research on osteochondral autograft transplantation and management,surgery,multidisciplinary integration and mechanisms of OLT,and its related diseases.Conclusions:The study provides information about the current status and hotspots of research in the domain of OLT over the past 18 years that will assist researchers in identifying potential perspectives on hot topics and research frontiers.

Development of an internally braced prosthesis for total talus replacement

Total loss of talus due to trauma or avascular necrosis,for example,still remains to be a major challenge in foot and ankle surgery with severely limited treatment options.Implantation of a custom made total talar prosthesis has shown promising results so far.Most important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ankle.Therefore,our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability.A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the S.T.A.R.prosthesis(Stryker).Additionally,four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important ligaments.Two modifications can be provided according to the clinical requirements:A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the S.T.A.R.total ankle replacement system.A feasibility study was performed using a fresh frozen human cadaver.Maximum range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus,valgus or sagittal stress with 150 N.Correct implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard instruments.Malleolar osteotomies were not required.Maximum ankle dorsiflexion and plantarflexion were measured as 22-0-28 degrees.Maximum anterior displacement of the talus was 6 mm,maximum varus tilt 3 degrees and maximum valgus tilt 2 degrees.Application of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

Cartilage repair techniques of the talus: An update

Symptomatic chondral or osteochondral defects of the talus reduce the quality of life of many patients.Although their pathomechanism is well understood,it is well known that different aetiologic factors play a role in their origin.Additionally,it is well recognised that the talar articular cartilage strongly differs from that in the knee.Despite this fact,many recommendations for the management of talar cartilage defects are based on approaches that were developed for the knee.Conservative treatment seems to work best in paediatric and adolescent patients with osteochondritis dissecans.However,depending on the size of the lesions,surgical approaches are necessary to treat many of these defects.Bone marrow stimulation techniques may achieve good results in small lesions.Large lesions may be treated by open procedures such as osteochondral autograft transfer or allograft transplantation.Autologous chondrocyte transplantation,as a restorative procedure,is well investigated in the knee and has been applied in the talus with increasing popularity and promising results but the evidence to date is poor.The goals of the current article are to summarise the different options for treating chondral and osteochondral defects of the talus and review the available literature.

Three-dimensional cellular automata based particle flow simulations of mechanical properties of talus deposit

Based on three-dimensional cellular automata （CA）, a new stochastic simulation model to simulate the microstructures and particle flow of talus deposit is proposed. Ill addition, an auto-modeling program CARS is developed, with which nunaerical simulations can be conducted conveniently. For the problem of simulating mechanical behaviors of talus deposit, spatial anangement or sphere shapes should be considered. In the new modeling method, four sphere anangement models are developed for the particle flow simulation of talus deposit. Numerical results show that the talus deposit has the mechanical characteristics of typical stress-strain curves, as other rock-like materials. The cohesion of talus deposit decreases with increasing rock content, while the internal friction angle increases with increasing rock contents. Finally, numerical simulation is verified with the results of field test.

Effects of Early Weightbearing on Microfracture Treatment of Osteochondral Lesions of Talus with Subchondral Bone Defects

When subchondral bone defects are present in osteochondral lesions of the talus(OCLT),it is inconclusive whether to allow early weightbearing after microfracture treatment because of the lack of effective support of the newly-formed fibrocartilage.After performing arthroscopic debridement and microfracture treatment on OCLT patients with subchondral bone defects,we allowed patients to have an early postoperative weightbearing exercise to observe their clinical outcome.Forty-two OCLT patients with subchondral bone defects were analyzed.Patients were randomly divided into two groups with 21 patients in each group.After arthroscopic debridement and microfracture treatment,group A was allowed to have early partial weightbearing while weightbearing was delayed in group B.Visual analogue scale(VAS)was used to evaluate joint pain before and after surgery.American Orthopaedic Foot and Ankle Society(AOFAS)anklc-hindfoot score was used to evaluate joint function.Tegner activity scale was used to assess patient's exercise level.The AOFAS ankle-hindfoot score in group A increased from 54.4 to 87.6,and that in group B increased from 54.9 to 87.3.The VAS score in group A decreased from 6.5 to 2.2,and that in group B decreased from 6.4 to 2.3.The Tegner activity scale increased from 2.6 to 4.4 in group A,and that in group B increased from 2.6 to 3.9.There was significant difference in the Tegner activity scale between group A and group B(P<0.05).It was suggested that when performing microfracture treatmenf on OCLT patients with subchondral bone defects,early postoperative weightbearing may achieve similar clinical outcomes as delayed weightbearing,and patients may be better able to return to sports.

Recurrent aneurysmal bone cyst of talus resulted in tibiotalocalcaneal arthrodesis

Aneurysmal bone cyst(ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. Arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement.

Directional arrangement of phyllite fragments in phyllite talus slopeat the eastern margin of the Tibetan Plateau

Phyllite fragments are essential for accumulating and generating talus slope at the toes of hillslopes,however,how they are linked to slope failure remains unknown.This paper reports the directional arrangement of phyllite fragments(DAPF)in phyllite talus slope at the eastern margin of the Tibetan Plateau.Field investigation,mathematical statistics and model experiments were performed in order to systematically understand the influencing factors,which include fragment shape,flat ratio,dip angle(α),and fine particle content(c).The results show that the quadrilateral fragmentgenerates a similar imbricate structure more easily than the triangular and rod fragments in the phyllite talus slope.Additionally,the flat phyllite fragments easily accumulate as imbricated structures on the phyllitetalus slope.When the dip angle(α)is in the range of 20°–30°,the minimum orientation ratio(P)is more than 50%,which means thatthe DAPF phenomenon is more obviousin the phyllite talus slope.For the fine particle content(c)at the same dip angle(α),the minimum orientation ratio(P)is 54%,and the minimum orientation ratio(P)correlates positively with the fine particle content(c).Therefore,compared with the homogeneous talusslope,the phyllite talusslopedisplays a special DAPF phenomenon.This study provides a valuable reference and presents novel knowledgefor risk assessment and engineering design against the phyllite talus slope failure mechanism.

Systematic review of bone marrow stimulation for osteochondral lesion of talus-evaluation for level and quality of clinical studies

AIM To clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation(BMS) for osteochondral lesions of the talus(OLT). METHODS Two reviewers searched the Pub Med/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence(LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score. RESULTS This review included 22 studies. Overall, 21 of the 22(95.5%) included studies were level Ⅳ or level Ⅲ evidences. The remaining study was a level Ⅱ evidence. MQOE analysis revealed 14 of the 22(63.6%) included studies having fair quality, 7(31.8%) studies having poor quality and only 1 study having excellent quality. CONCLUSION The evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.

Osteochondral lesion of talus with gout tophi deposition:A case report

BACKGROUND Osteochondral lesion of talus is a broad term used to describe an injury or abnormality of the talar articular cartilage and adjacent bone.It arises from diverse causes,and although trauma is implicated in many cases,it does not account for the etiology of every lesion.Gout is a chronic arthritic disease caused by excess levels of uric acid in blood.Intraosseous deposition of monosodium urate in the clavicle,femur,patella and calcaneus was reported previously.Gout is common disease but rare at a young age,especially during teenage years.Osteochondral lesion caused by intra-articular gouty invasion is very rare.CASE SUMMARY We encountered a rare case of a 16-year-old male who has osteochondral lesion of the talus(OLT)with gout.He had fluctuating pain for more than 2 years.We could see intra-articular tophi with magnetic resonance image(MRI)and arthroscopy.We performed arthroscopic exploration,debridement and microfracture.Symptoms were resolved after operation,and bony coverage at the lesion was seen on postoperative images.We had checked image and uric acid levels for 18 mo.CONCLUSION It is rare to see OLT with gouty tophi in young adults.While it is challenging,the accuracy of diagnosis can be improved through history taking,MRI and arthroscopy.

Effect of Talus Deposit Excavations on Hydrogeochemical Characteristics of Kuvars Spring Water, Maltepe, Istanbul, Turkey

Spring waters consumed for drinking purposes should be clean and quality. These waters with balanced mineral distribution, which do not contain organic substances, whose physical and chemical caharacteristics comply with certain quality parameters and which do not negatively affect human health are identified as healthy water. Kuvars water is a spring water which is pumped out from the draw well at the Camurluk stream basin of Maltepe province of Istanbul and filled into bottles. The Camurluk stream basin is approximately 4.5 km2. The Camurluk stream basin is sedimentary rocks and talus deposit outcrops. Reaching of trace elements, which is found more in the talus deposit samples than outcropping quartzarenite at the basin, to underground aquifer as ions under effect of rains, water rock interaction, leakage and filtration, is prevented by illite type clay levels existing within the talus deposit stack, which have upto 20 cm thickness. However, negative effects of the excavation that were made at the talus deposit reflect on the hydrologic cycle and chemical compositions of well waters. This effect was at first negatively affected the physical characteristics of the well waters. During the rainy periods, the water in the excavated area which was enriched with respect to the suspended sediments was percolated into the groundwaters from the joints and cracks of the quartzarenite. The turbidity value measured in the well waters of K2 and K3 were determined as 40.3 NTU and 34.2 NTU respectively. Although at the basin, the aquifer of underground water and the well waters being managed are quartzarenite, the fact that water types belonging to well waters differ (they are not same) according to the Piper diagram and when the heavy metal content of the water of well numbered KS1 is taken as basis, that some heavy metals such as Al3+, Fe2+, Ni2+, Mn2+ and Cu2+ be enriched 3 to 40 times in KS2 and KS3 well waters, are caused by talus deposit—water interaction at the excavation area. After a rainfall, in the water that became turbid with the water-talus deposit interaction at the excavation area, the water-mineral interaction has caused the limit value for drinking water suggested by World Health Organization (WHO) to be exceeded with the Al3+ concentration of 189 ppb detected in KS2 well water and Fe2+ concentration of 185 ppb has caused to approach the drinking water limit value of 200 ppb permitted by World Health Organization (WHO), United States Environmental Protection Agency (EPA), European Union (EU) and Turkish Standards (TS). Therefore, at the water basins where bottled spring waters consumed for drinking purposes are produced, technical undertakings that shall disturb the stability of geological units should not be permitted.

Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus

BACKGROUND The Ankle Spacer was developed as a joint-sparing alternative to invasive endstage surgeries.Currently,there are no clinical studies on the Ankle Spacer.AIM To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple,cystic osteochondral lesions of the talus in patients with failed prior operative treatment.METHODS This is a prospective study during which patients were assessed preoperatively,at 2-and 6 wk,and at 3,6,12 and 24 mo postoperatively.Patients with multiple,cystic or large(≥15 mm)osteochondral lesions of the talus after failed prior surgery were included.The primary outcome measure was the numeric rating scale(NRS)for pain during walking at 2 years postoperatively.Secondary outcome measures included the NRS in rest and during stair climbing,the American Orthopaedic Foot and Ankle Society Hindfoot Score,the Foot and Ankle Outcome Score,the Short-Form 36 physical and mental component scale,and the Range of Motion(ROM).Radiographic evaluations were conducted to evaluate prosthetic loosening and subsidence.Revision rates and complications were also assessed.RESULTS Two patients underwent an Ankle Spacer implantation on the talus.The NRS during walking improved from 6 and 7 preoperatively to 2 and 2 points postoperatively at 2 years,in patient 1 and 2,respectively.The other patient-reported outcome measures also improved substantially.There were no re-operations nor complications.Radiological imaging showed no loosening of the implant and no change of implant position.CONCLUSION The Ankle Spacer showed clinically relevant pain reduction during walking,improvement in clinical outcomes as assessed with PROMs,and no complications or re-operations.This treatment option may evolve as a joint-sparing alternative to invasive end-stage surgeries.

Fracture Bilateral Talus in Children

Talar body injuries are rare, particularly in children. To our knowledge, there has not been a single case report of bilateral talus fracture in a child till date. We report two cases of fracture bilateral talus in children. The first case is of a fracture separation of the distal tibial epiphysis and a fracture of the body of the talus with subluxation of ankle on right side and a fracture neck of talus on left side. The second is fracture bilateral talus with epiphyseal injury of left distal tibia. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required.

Aneurysmal Bone Cyst of Talus: A Rare Case

Aneurysmal bone cyst is a benign locally aggressive lytic lesion usually involving metaphyseal regions of long tubular bones. It rarely involves talus. It can be primary or secondary in origin. We reported the imaging findings in a case of a 23-year-old male patient with complaints of pain and swelling around left ankle joint one year ago which turned out to be aneurysmal bone cyst on histopathology.

Erdheim-Chester disease with asymmetric talus involvement: A case report

BACKGROUND Erdheim-Chester disease(ECD) is a rare multi-system or multi-organ histiocytic proliferative disease with diverse clinical manifestations, and the development of the disease is complex, which makes clinical diagnosis and treatment difficult.The characteristic clinical manifestations include multi-organ involvement,especially in the symmetrical diaphysis and metaphysis of the bilateral extremities. ECD with a unilateral talus lesion is extremely rare. Here, we report an unusual case of ECD invading the asymmetric talus and tibia without involving other organs. The patient had good outcome after surgery.CASE SUMMARY We report a case of a 67-year-old man who was referred to our outpatient department because of left ankle chronic pain for 5 years, which exacerbated after a foot sprain 6 mo previously. We discovered multiple sclerotic lesions of the tibia and talus on his previous X-ray films, which were initially missed in a local hospital. Therefore, enhanced computer computed tomography(CT) and magnetic resonance imaging were performed. These examinations showed multiple lesions in the bone marrow cavity of the left tibia, and cortical sclerosis and osteonecrosis of the left talus. Specimens were collected via bone puncture from the two lesions, and a final diagnosis of ECD was confirmed by pathological and immunohistochemical examinations. In addition, other auxiliary examinations including head CT, pulmonary CT, spinal CT, abdominal CT,cardiac ultrasound and thyroid ultrasound showed no obvious abnormalities.The patient underwent surgery for the tibia lesion scraping and talus lesion scraping combined with cement casting. The patient started on a progressive rehabilitation at 4 wk, and felt no pain after surgery. During a 2-year follow-up period, the patient exercised normally without pain, and there were no signs of recurrence.CONCLUSION This study shows that surgery treatment may also achieve good results for ECD patients with only bone involvement.

Effects of freeze-thaw cycles on sandstone in sunny and shady slopes

A growing rock engineering activity in cold regions is facing the threat of freeze-thaw(FT)weathering,especially in high mountains where the sunny-shady slope effects strongly control the difference in weathering behavior of rocks.In this paper,an investigation of the degradation of petrophysical characteristics of sandstone specimens subjected to FT cycle tests to simulate the sunny-shady slope effects is presented.To this aim,non-destructive and repeatable testing techniques including weight,ultrasonic waves,and nuclear magnetic resonance methods on standard specimens were performed.For the sunny slope specimens,accompanied by the enlargement of small pores,100 FT cycles caused a significant decrease in P-wave velocity with an average of 23%,but a consistent rise of 0.18%in mass loss,34%in porosity,67%in pore geometrical mean radius,and a remarkable 14.5-fold increase in permeability.However,slight changes with some abnormal trends in physical parameters of the shady slope specimens were observed during FT cycling,which can be attributed to superficial granular disaggregation and pore throat obstruction.Thermal shocks enhance rock weathering on sunny slopes during FT cycles,while FT weathering on shady slopes is restricted to the small pores and the superficial cover.These two factors are primarily responsible for the differences in FT weathering intensity between sunny and shady slopes.The conclusions derived from the interpretation of the experimental results may provide theoretical guidance for the design of slope-failure prevention measures and the selection of transportation routes in cold mountainous regions.

全新Talus1.2提供更快速、更高级的布线及时序和提取技术

进行32／28nm节点设计时会遇到许许多多的问题，其中包括：低功耗设计、串扰效应、工艺变异及操作模式和角点数量的显著增加。日前，芯片设计解决方案供应商微捷码（Magma）公司推出了下一代集成电路（IC）实施解决方案——Talus1．2，它可显著缩短片上系统（SoC）的设计周期。

Original article： Arthroscopic treatment for osteochondral lesions of the talus： analysis of outcome predictors

Background Compared with traditional arthrotomy procedures, arthroscopic treatment for osteochondral lesions of the talus has some advantages. However, there has been considerable debate about the outcome predictors for this surgical technique. This study aimed to investigate the outcomes of arthroscopic treatment for osteochondral lesions of the talus, and analyze its outcome predictors. Methods Clinical data of 48 patients with osteochondral lesions of the talus who underwent ankle arthroscopy were studied. Arthroscopic debridement was performed on all patients, and microfracture was also performed in 36 cases. Scores on a subjective satisfaction questionnaire, visual analog scale （VAS） for pain, and the American Orthopedic Foot ＆ Ankle Society （AOFAS） ankle and hindfoot scores were obtained before and after surgery. Results Five patients lost to follow up. The other forty-three patients, 8 of whom were athletes, were followed up for an average of 23.9 months. The average AOFAS post-operative score was 90.16±9.96, compared with 70.81±6.96 before surgery （t=9.353, P 〈0.001）. The VAS pain score after the operation （2.51±2.45） was significantly lower than that before the operation （6.95±.40） （t=8.647, P 〈0.001 ）. Of the 43 patients, 35 （81.4%） had good or excellent results. There was no significant difference in outcome between the medial and lateral groups （z=0.205, P=0.838）, while a better outcome was found with lesions smaller than 10 mm than those with larger lesions （z=2.199, P=0.028）. Age, sex, athletic profession and location of the lesion did not significantly correlate with outcomes. Conclusions Arthroscopic treatment is effective and safe for osteochondral lesions of the talus. A strong correlation was found between the size of the lesion and successful outcome.

Osteochondral autograft transfer (mosaicplasty) for treatment of patients with osteochondral lesions of talus

Purpose:Osteochondral lesion of talus(OLT)is one of the common causes of ankle pain.This disorder is common in young athletes after ankle injury.There are various therapeutic options.One of the options is mosaic plasticizer.The purpose of this study was to investigate the effect of mosaicplasty on improvement of symptoms of patients with osteochondral lesions of talus.Methods:Nineteen patients with osteochondral lesions of talus participated in this study,who were treated with mosaicplasty.Before and after treatment,pain(visual analogue scale),function(American Orthopaedic Foot and Ankle Society),range of motion and radiographic signs were evaluated.Results:The results of this study showed that mosaicplasty could significantly reduce pain,increase function and improve radiographic symptoms.The range of motion increased after treatment,which was not significant.Conclusion:We can confirm the effect of mosaicplasty on the improvement of patients with osteochondral lesions of the ankle,suggesting it as a treatment option.