![]() ![]() In case of avascular necrosis of the talus talectomy with tibiocalcanear fusion is favoured over talar prosthesis or more rigorous interventions such as partial amputation as was customary in the 1980s. Necrosis of the talar bone alone is not an indication for surgery, only in case of persisting pain and disability due to talar dome collapse operative options should be considered. In case of combined non-union of the fracture and persisting pain diagnostics should be performed to confirm avascular necrosis. It indicates that there is sufficient vascularity in the talus and it is unlikely to develop an avascular necrosis later. The Hawkins sign describes subchondral lucency of the talar dome that occurs secondary to subchondral atrophy due to inactivity six to eight weeks after a talar neck fracture. Signs of revascularisation can be seen on ankle radiographs six to twelve weeks after trauma. One year after tibiocalcanear fusion patient is in good physical condition and fairly pain free with transcutaneous electro neuro stimulation.ĭuring follow up the treating physician should always keep the possibility of avascular necrosis in mind. Six weeks after surgery patient resumed weightbearing activities. ![]() The combination of avascular necrosis, low-grade infection and pain warranted a talectomy followed by a tibiocalcanear fusion. CT scans showed a non-union of the talar fracture, the vascularity of the talus could not be determined by the CT scan. Patient did regain limited motion of the ankle joint but pain persisted. Rehabilitation was complicated by a wound infection. After ten months a subtalar arthrodesis with a cannulated screw and iliac crest bone graft was performed because of pain caused by arthritis due to incongruent articulating surface. X-rays six and twelve weeks post injury did not indicate avascular necrosis of the talus. Sixteen days post injury internal fixation was performed. Treatment consisted of open reduction followed by an external fixator to maintain adequate reposition and to monitor the soft tissues. He was involved in a high-energy motor vehicle accident and suffered from several injuries amongst which a severely dislocated talar fracture type Hawkins IV ( Fig. Three years after the incident the patient has resumed sporting activities and only reports minor pain, after intensive sporting activities, which is manageable without pain killers.Ī 51-year old smoker male without relevant medical history. Considering the location of the pain and the radiographic findings an arthroscopic nettoyage of the involved region and a k-wire removal was performed with good results. CT radiography showed mild subtalar and talonavicular arthritis, moderate collapse of the talar dome and a bony impingement exactly at the location of the complaints. Two years after the initial treatment the patient suffered from local pain. No complications occurred and ten weeks after surgery there were no signs of avascular necrosis on radiologic imaging. ![]() Antibiotics were prescribed because of the open nature of the fracture. An external fixator was placed to assure stability. Patient was taken to theatre where open reduction was successful and fixation of the comminuted fracture was performed with two k-wires and two screws. Radiography showed a tibiotalar and subtalar dislocation, classified as a Hawkins III fracture ( Fig. Sensibility and vascularisation of the foot were normal. He had a severe medial dislocation of the ankle with a lateroventral open luxation of the talus. A 51-year old male, without relevant medical history, who fell off a ladder, landing on his left ankle.
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