Radiomorphological Parameters of the Foot Bones During the Talus Fracture Treatment Using the Ilizarov Apparatus
https://doi.org/10.35401/2541-9897-2023-26-3-20-30
Abstract
Background: Talus fractures are one of the most dangerous injuries leading to serious consequences. Quite a lot of treatment methods have been proposed, but the use of the Ilizarov apparatus is relatively rare.
Objective: To justify the use of the Ilizarov apparatus in the talus fracture treatment by studying radiomorphological parameters of the foot bones at different stages of follow-up.
Methods: We used radiography and multislice computed tomography (MSCT) in 25 patients treated for talus injuries by the Ilizarov apparatus to study radiographic and radiomorphological features of the foot bones at different stages of follow-up. We analyzed normal parameters of the foot bones forming the ankle joint in 15 patients.
Results and discussion: Dynamics of talus radiomorphology during its fracture or fracture-dislocation are characterized by a gradual increase in the bone density at the union site. The local density of the talus at the fracture site gradually increased and exceeded 500 HU in 6 months. The organotypic adjustment at the union site did not end by this time, given the architecture of the talus and the biomechanics of the foot. We observed a decrease in the total densities of the talus and calcaneus during fixation by the Ilizarov apparatus and their gradual return to normal values after removal of the apparatus.
Conclusions: Talus fracture treatment by transosseous osteosynthesis using the Ilizarov apparatus makes it possible to get immediate good results, especially using a configuration with hinges allowing for early mobilization of the ankle joint and loading in the early stages of treatment.
About the Authors
G. V. DiachkovaRussian Federation
Galina V. Diachkova, Dr. Sci. (Med.), Professor, Head of the Laboratory
Laboratory of Diagnostic Radiology and Ultrasound Techniques
640014
ulitsa M. Ulyanovoy 6
Kurgan
V. A. Naritsyn
Russian Federation
Vitaliy A. Naritsyn, Traumatologist-Orthopedist, Head of the Department
Department of Trauma and Orthopedics No. 3
Kurgan
I. V. Sutyagin
Russian Federation
Ilya V. Sutyagin, Resident
Kurgan
K. A. Diachkov
Russian Federation
Konstantin A. Diachkov, Dr. Sci. (Med.), Principal Researcher, Head of the Department
Laboratory of Diagnostic Radiology and Ultrasound Techniques
Diagnostic Radiology Department
Kurgan
I. I. Martel
Russian Federation
Ivan I. Martel, Dr. Sci. (Med.), Traumatologist-Orthopedist
Kurgan
N. A. Sazonova
Russian Federation
Natalia A. Sazonova, Dr. Sci. (Med.), Head of the Polyclinic
Kurgan
References
1. Fournier A, Barba N, Steiger V, et al. Total talar fracture – long-term results of internal fixation of talar fractures. A multicentric study of 114 cases. Orthop Traumatol Surg Res. 2012;98(4 Suppl):S48–S55. PMID: 22621831. doi: 10.1016/j.otsr.2012.04.012
2. Buza JA 3<sup>rd</sup>, Leucht P. Fractures of the talus: current concepts and new developments. Foot Ankle Surg. 2018;24(4):282–290. PMID: 29409210. doi: 10.1016/j.fas.2017.04.008
3. Jermander E, Sundkvist J, Ekelund J, Möller M, Wolf O, Mukka S. Epidemiology, classification, treatment and mortality of Talus fractures: an observational study of 1794 talus fractures from the Swedish Fracture Register. Foot Ankle Surg. 2022;28(8):1444–1451. PMID: 36028442. doi: 10.1016/j.fas.2022.08.008
4. Liu X, Zhang H, Liu L, Fang Y, Huang F. Open talus fractures: early infection and its epidemiological characteristics. J Foot Ankle Surg. 2019;58(1):103–108. PMID: 30448380. doi: 10.1053/j.jfas.2018.08.020
5. Sautet P, Roussignol X, Loubignac F, Rochwerger RA, Pidhorz L; la Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT). Talar fracture: epidemiology, treatment and results in a multicenter series. Orthop Traumatol Surg Res. 2021;107(6):102835. PMID: 33524630. doi: 10.1016/j.otsr.2021.102835
6. Carlock KD, Bunzel EW, Goodnough LH, Githens MF. Posteromedial talar body fracture: case discussion and surgical technique. J Orthop Trauma. 2022;36(Suppl 3):S33–S34. PMID: 35838577. doi: 10.1097/BOT.0000000000002398
7. Githens M, Tangtiphaiboontana J, Carlock K, Campbell ST. Talus fractures: an update on current concepts in surgical management. J Am Acad Orthop Surg. 2022;30(15):e1015–e1024. PMID: 35862213. doi: 10.5435/JAAOS-D-20-01348
8. DeLong WG Jr, Born CT, Wei SY, Petrik ME, Ponzio R, Schwab CW. Aggressive treatment of 119 open fracture wounds. J Trauma. 1999;46(6):1049–1054. PMID: 10372623. doi: 10.1097/00005373-199906000-00012
9. Athavale SA, Joshi SD, Joshi SS. Internal architecture of the talus. Foot Ankle Int. 2008;29(1):82–86. PMID: 18275743. doi: 10.3113/FAI.2008.0082
10. Pal GP, Routal RV. Architecture of the cancellous bone of the human talus. Anat Rec. 1998;252(2):185–193. PMID: 9776073. doi: 10.1002/(SICI)1097-0185(199810)252:2<185::AID-AR4>3.0.CO;2-2
11. Schiff A, Li J, Inoue N, Masuda K, Lidtke R, Muehleman C. Trabecular angle of the human talus is associated with the level of cartilage degeneration. J Musculoskelet Neuronal Interact. 2007;7(3):224–230. PMID: 17947804.
12. Ebraheim NA, Sabry FF, Nadim Y. Internal architecture of the talus: implication for talar fracture. Foot Ankle Int. 1999;20(12):794–796. PMID: 10609708. doi: 10.1177/107110079902001207
13. Fan ZR, Ma JX, Zhao XW, et al. Spatial structure of talus trabeculae based on high resolution X-ray and micro-CT. Zhonghua Yi Xue Za Zhi. 2021;101(37):2982–2987. (In Chinese). PMID: 34638188. doi: 10.3760/cma.j.cn112137-20210608-01306
14. Rammelt S, Zwipp H. Talar neck and body fractures. Injury. 2009;40(2):120–135. PMID: 18439608. doi: 10.1016/j.injury.2008.01.021
15. Williams T, Barba N, Noailles T, et al. Total talar fracture – inter- and intra-observer reproducibility of two classification systems (Hawkins and AO) for central talar fractures. Orthop Traumatol Surg Res. 2012;98(4 Suppl):S56–S65. PMID: 22613935. doi: 10.1016/j.otsr.2012.04.011
16. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991–1002. PMID: 5479485.
17. Alexandrov SM, Diachkova GV, Diachkov KA, Stepanov RV, Larionova TA. Multispiral CT-semiotics of chronic osteomyelitis of the bones forming the ankle joint. Vestnik Rossiiskogo Nauchnogo Tsentra rentgenoradiologii Minzdrava Rossii. 2014;14. (In Russ.). http://vestnik.rncrr.ru/vestnik/v14/papers/diachkova_v14.pdf
18. Krause M, Rupprecht M, Mumme M, Püschel K, Amling M, Barvencik F. Bone microarchitecture of the talus changes with aging. Clin Orthop Relat Res. 2013;471(11):3663–3671. PMID: 23893363. PMCID: PMC3792264. doi: 10.1007/s11999-013-3195-0
19. Gelberman RH, Mortensen WW. The arterial anatomy of the talus. Foot Ankle. 1983;4(2):64–72. PMID: 6642325. doi: 10.1177/107110078300400204
20. Diachkova GV, Neretin AS, Korabelnikov MA, Nizhechick SA. The roentgenologic peculiarities of bone tissue regeneration in treatment of patients with developmental foot anomalies. Genij Ortopedii. 2005;(4):98–101. (In Russ.).
21. Sproule JA, Glazebrook MA, Younger AS. Varus hindfoot deformity after talar fracture. Foot Ankle Clin. 2012;17(1):117–125. PMID: 22284556. doi: 10.1016/j.fcl.2011.11.009
22. Sen RK, Tripathy SK, Manoharan SR, Krishnan V, Tamuk T, Jagadeesh V. Long term surgical treatment outcome of talar body fracture. Chin J Traumatol. 2011;14(5):282–287. PMID: 22118482.
23. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am. 1976;58(3):356–357. PMID: 1262367.
24. Yeganeh A, Alaee A, Boddouhi B, Behkam-Rad A, Shahoseini G. Results of surgically treated talar fractures. Chin J Traumatol. 2013;16(6):361–364. PMID: 24295584.
25. Sangeorzan BJ, Wagner UA, Harrington RM, Tencer AF. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. J Orthop Res. 1992;10(4):544–551. PMID: 1613628. doi: 10.1002/jor.1100100409
Review
For citations:
Diachkova G.V., Naritsyn V.A., Sutyagin I.V., Diachkov K.A., Martel I.I., Sazonova N.A. Radiomorphological Parameters of the Foot Bones During the Talus Fracture Treatment Using the Ilizarov Apparatus. Innovative Medicine of Kuban. 2023;(3):20-30. (In Russ.) https://doi.org/10.35401/2541-9897-2023-26-3-20-30