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Assessment of ankle and hindfoot stability and joint pressures using a human cadaveric model of a large lateral talar process excision: a biomechanical study.

Abstract：

:Lateral talar process fragment excision may be followed by hindfoot instability and altered biomechanics. There is controversy regarding the ideal fragment size for internal fixation versus excision and a concern that excision of a large fragment may lead to significant instability. The aim of this study was to assess the effect of a simulated large lateral talar process excision on ankle and subtalar joint stability.A custom-made seesaw rig was designed to apply inversion/eversion stress loading on 7 fresh-frozen human cadaveric lower legs and investigate them in pre-excision, 5 cm and 10 cm lateral talar process fragment excision states. Anteroposterior radiographs were taken to assess ankle and subtalar joint tilt and calculate angular change from neutral hindfoot alignment to 10-kg forced inversion/eversion. Ankle joint pressures and contact areas were measured under 30-kg axial load in neutral hindfoot alignment.In comparison to the pre-excision state, no significantly different mediolateral angular change was observed in the subtalar joint after 5 and 10 cm lateral talar process fragment excision in inversion and eversion. With respect to the ankle joint, 10-cm fragment excision produced significantly bigger inversion tibiotalar tilt compared with the pre-excision state, P = .04. No significant change of the ankle joint pressure and contact area was detected after 5 and 10-cm excision in comparison with the pre-excison state.An excision of up to 10 cm of the lateral talar process does not cause a significant instability at the level of the subtalar joint but might be a destabilizing factor at the ankle joint under inversion stress. The latter could be related to extensive soft tissue dissection required for resection.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Sands A,White C,Blankstein M,Zderic I,Wahl D,Ernst M,Windolf M,Hagen JE,Richards RG,Stoffel K,Gueorguiev B

doi

10.1097/MD.0000000000000606

subject

Has Abstract

pub_date

2015-03-01 00:00:00

pages

e606

issue

eissn

0025-7974

issn

1536-5964

pii

00005792-201503030-00009

journal_volume

pub_type

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Assessment of ankle and hindfoot stability and joint pressures using a human cadaveric model of a large lateral talar process excision: a biomechanical study.