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Talar injuries: The orthopedic challenge
Le?i? Aleksandar R.,Zagorac Slavi?a G.,Bumba?irevi? Marko ?.
Acta Chirurgica Iugoslavica , 2012, DOI: 10.2298/aci1201025l
Abstract: Injuries of the talus represents an important part of the foot and ankle trauma. Since talar bone connect the lower limb and foot, the sequelas of its trauma could have significant influence on the function of the whole lower limb and gait. The specific vascularization of the talus results in delayed union and even in the avascular necrosis. The diagnosis of the fractures of the talus can be made on the x-rays, but sometimes real picture of the fracture pattern can be seen only in the CT scans. Ocult fractures such as osteochondral fractures and avascular necrosis can be exactly detected on MRI in aim not to be overlookded as the ankle sprain diagnosis. The precise reduction and stable internal fixation is mandatory in the treatment to enable the anatomical position of the talonavicular, talocrural and subtalar joint and to make possible early motion and rehabilitation, without weight bearing. On the other hand, crushed fractures, open fractures and the Hawkins III - IV fractures with the dislocations of the talar body sometimes needs salvage procedures like Blair or tibio-talar or tibio-calcaneal fusion.[Acknowledgment. Projekat Ministarstva nauke Republike Srbije, br. 175095 and 45005]
Types of Talar Articular Facets and Morphometric Measurements of The Human Calcaneus Bone  [cached]
Nagar SK,Malukar Ojaswini,Kubavat Dharati,Gosai SR
National Journal of Medical Research , 2012,
Abstract: Introduction: The calcaneum is the largest tarsal bone. On its dorsal or superior surface, there are three articular facets for the talus. Objective: The main purpose of the present study has been to find the incidences of variations in types of the talar facets and their association with racial factors, if any. The other objective of the study has been is to find the relation between the total length of the calcanei and the types of calcanei. Method: In the present study of 529 calcanei of unknown sex in Gujarat State, were studied. Result: We found that in 73.67 % of calcanei, the anterior and the middle facets are continuous with each other and in 22.3 % calcanei these two facets are separate from each other. In 1.13 % calcanei, the anterior facet is absent. Conclusion: The study shows racial similarities and differences. The study will serve as a prelude for biomechanics of foot. [National J of Med Res 2012; 2(2.000): 128-132]
The Professional Medical Journal , 2006,
Abstract: Introduction: Talus & Calcaneum are involved in the transmissionof body weight to the ground, considerable variation in the morphological features and weight of these bones havebeen reported by various authors. Objectives: To determine the importance of bone weight as a discriminative factorin identification of sex. Material and Method: 198 calcanei and 150 tali from Anatomy department of Quaid-e-AzamMedical College Bahawalpur were selected for the study. Mean weight of male & female bones on right & left side weredetermined. To increase the efficacy of the results they were statistically reevaluated by applying ±3SD anddetermining a calculated range. From this range, D.P. or demarcating points were established. Results: Bones of theright side were found to be heavier than those of the left side; also the mean weights of the male bones were greaterthan those of the female bones. On applying D.P.s it was possible to identify sex with greater accuracy than with othermetrical criteria. Conclusion: These findings suggest that weight of tarsal bones is a useful metrical feature for sexdetermination.
Biomechanical investigation of a novel ratcheting arthrodesis nail
Jeremy J McCormick, Xinning Li, Douglas R Weiss, Kristen L Billiar, John J Wixted
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-74
Abstract: A novel ratcheting nail was designed and mechanically tested in comparison to a solid nail and a threaded nail using sawbones models (Pacific Research Laboratories, Inc.). Intramedullary nails (IM) were implanted with a load cell (Futek LTH 500) between fusion surfaces. Constructs were then placed into a servo-hydraulic test frame (Model 858 Mini-bionix, MTS Systems) for application of 3 mm and 6 mm dynamic axial displacement (n = 3/group). Load to failure was also measured.Mean percent of initial load after 3-mm and 6-mm displacement was 190.4% and 186.0% for the solid nail, 80.7% and 63.0% for the threaded nail, and 286.4% and 829.0% for the ratcheting nail, respectively. Stress-shielding (as percentage of maximum load per test) after 3-mm and 6-mm displacement averaged 34.8% and 28.7% (solid nail), 40.3% and 40.9% (threaded nail), and 18.5% and 11.5% (ratcheting nail), respectively. In the 6-mm trials, statistically significant increase in initial load and decrease in stress-shielding for the ratcheting vs. solid nail (p = 0.029, p = 0.001) and vs. threaded nail (p = 0.012, p = 0.002) was observed. Load to failure for the ratcheting nail; 599.0 lbs, threaded nail; 508.8 lbs, and solid nail; 688.1 lbs.With significantly increase of compressive load while decreasing stress-shielding at 6-mm of dynamic displacement, the ratcheting mechanism in IM nails may clinically improve rates of fusion.Intramedullary (IM) implants are used clinically to provide stability and expedite fracture healing and fusion [1-5]. IM devices may be utilized to facilitate femoral-tibial (knee) [3,5-9] or tibio-talo-calcaneal (TTC) fusion [4,10,11]. Knee fusion is most commonly performed for failed total knee arthroplasty secondary to multiple infections or severe post traumatic arthritis [1,5,9,12]. TTC fusion is a salvage procedure performed in patients with severe pain and/or deformity as seen in complex hindfoot fractures or congenital deformities, septic arthritis, failed total ankle art
Giant cell tumour of talar body.  [cached]
Bapat M,Narlawar R,Pimple M,Bhosale P
Journal of Postgraduate Medicine , 2000,
Abstract: Giant cell tumour (osteoclastoma) of talar bone is a rare entity and is seen more commonly in the third decade of life. We report this disease entity in a 17-years-old girl. The patient presented with painful swelling of the left ankle with an osteolytic lesion in the talus on conventional radiographs. Intralesional curettage and autologous bone grafting was performed following which patient′s pain and swelling disappeared. Complete range of movement at the ankle joint was regained with minimal restriction at the subtalar joint. There is no evidence of relapse at six months follow up.
Lichen striatus with nail involvement  [cached]
Inamadar Arun
Indian Journal of Dermatology, Venereology and Leprology , 2001,
Abstract: A 13 - year-old boy of lichen striatus (LS) with nail changes is reported. Nail involvement in LS is rare. Nail LS is to be considered if - longitudinal ridges and splitting localized to one portion of the nail, single nail involvement and presence of skin lesions near the nail.
Geniculate arterial pseudoaneurysm formation following trauma and elective orthopaedic surgery to the knee: 2 case reports and a review of the literature  [cached]
Aidan Shaw,A B Stephen,J N Lund,P Bungay
Journal of Radiology Case Reports , 2009, DOI: 10.3941/jrcr.v3i3.42
Abstract: Arterial pseudoaneurysm formation of the genicular vessels following orthopaedic surgery to the knee is an extremely rare occurrence. Here we report the successful management of two cases as a complication of total knee arthroplasty and a tibial interlocking nail, utilising coil embolisation by interventional radiological techniques and negating the need for further surgery. To our knowledge this is one of the few reported cases of pseudoaneurysms of the descending genicular artery secondary to drain placement and only the second following tibial interlocking nail placement.
Nail Surgery for Beginners
Güne? Gür
Turkderm , 2010,
Abstract: Nail diseases have a negative impact on quality of life both by causing esthetic concerns and functional disturbances. Many disorders of the nail require nail surgery for diagnosis and treatment. Dermatologists, however, often refrain from surgical interventions of the nail due to prejudices that they are delicate and hard to perform. Appreciation of nail anatomy will render nail surgical interventions fast and easy with favorable results. Here, nail anatomy and basic nail surgical interventions that we often need to use in everyday practice are discussed.
Nail Isthmus: A Distinct Region of the Nail Apparatus  [PDF]
Naoki Oiso,Ichiro Kurokawa,Akira Kawada
Dermatology Research and Practice , 2012, DOI: 10.1155/2012/925023
Abstract: The nail unit is constructed by distinctly regulated components. The nail isthmus is a lately proposed region as a transitional zone between the most distal part of the nail bed and the hyponychium. It is difficult to recognize the nail isthmus in the normal nail, but it is easy to identify the region in nail disorders such as pterygium inversum unguis and ectopic nail. We describe structure and putative function of the nail isthmus via histopathologic features of pterygium inversum unguis and ectopic nail. 1. The Nail Isthmus The nail unit has distinct structure. The concept of the nail isthmus was recently proposed by Perrin in 2007 [1]. The region is present in the transitional zone between the most digital part of the nail bed and the hyponychium (Figure 1) [1–3]. Perrin described the four typical features of the nail isthmus: (i) the maintenance of the longitudinal ridge pattern of the nail bed, (ii) a discontinuous and thin granular layer, (iii) a peculiar and thin compartment of pale and nucleated corneocytes, and (iv) a profile of transitional keratin expression [1–3]. The nail isthmus is almost invisible in the normal nail, but it is able to be identified in nail disorders such as pterygium inversum unguis [4] and ectopic nail [5]. Figure 1: A diagram of the nail apparatus. The nail isthmus is present in the transitional zone between the most digital part of the nail bed and the hyponychium. 2. The Structure of the Nail Isthmus The nail isthmus is composed of two distinct parts. A histopathological study of the nail isthmus with a case of pterygium inversum unguis identified two substances: (i) a marked, highly eosinophilic, keratinized substance attaching the distal and visceral nail plate and (ii) a whorled, highly eosinophilic, keratinized substance into the horny layer of the finger tip (Figures 2 and 3) [4]. The former substance is constructed by an extraordinary mode of keratinization with a compartment of pale and nucleated corneocytes [1, 4]. Another histopathological study with a case of ectopic nail (Figures 4 and 5) showed two distinct parts: (i) a proximal and narrow part anchored to the nail plate and (ii) a distal and wide part constructed with highly eosinophilic structure [5]. Figure 2: A ventral appearance of pterygium inversum unguis in a 16-year-old Japanese man. Marked subungual keratotic thickening is present on the distal nail unit of the left fingers (arrows). Figure 3: A biopsy specimen from the left second finger showed (i) a marked, highly eosinophilic, keratinized substance attaching the distal and visceral nail plate
Aneurysmal bone cyst of the calcaneum: An expansile locally destructive lesion  [cached]
Malik Ajay,Deb Prabal,Mani N,D′Souza John
Journal of Cancer Research and Therapeutics , 2010,
Abstract: Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion affection of which in the calcaneum has rarely been reported in the literature. We report an unusual case of ABC of the calcaneum in a 17-year-old-male, who presented with painful ankle swelling with difficulty in walking. Radiology revealed benign cystic calcaneal lesion, without any evidence of fracture. Biopsy was characterized by formation of osteoid along with the presence of ecstatic blood-filled channels, consistent with ABC. However, this being an uncommon site for ABC, histopathology needs to be used to differentiate it from other benign and malignant entities, and a definitive diagnosis warrants clinical and radiological correlation. Most of the ABCs require surgical curetting and bone engraftment of the surgical defect.
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