Chronic Ankle Pain Secondary to Talus Partitus: Two Case Reports

Eichenbaum, Matthew D.; Austin, Luke; Raikin, Steven M.

doi:10.3113/fai.2010.0247

Cited by 10 publications

(16 citation statements)

References 2 publications

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“…Consequently, the resulting ossicle was broader on the lateral side because of the bigger size of the lateral tubercle of the posterior process as compared with the medial tubercle. These findings are consistent with the findings of the single axial CT images shown in two previous case reports 5,7 . Because all six cases were associated with an oblique course of the cleft, the term ''frontal split'' seems inaccurate and would best not be used as a synonym for this skeletal variant.…”

Section: E21(4)supporting

confidence: 93%

“…Short-term pain relief was reported, but pain recurred two years later along with 10°of restriction of ankle dorsiflexion. Recently, Eichenbaum et al 7 reported on two patients with symptomatic talus bipartitus. In an eighteen-year-old man who had a history of ankle pain for more than four years, surgical exploration revealed a dysmorphic fragment with signs of arthritis at the subtalar joint.…”

Section: E21(4)mentioning

confidence: 99%

“…If signs of subtalar or ankle arthritis are seen, or if the ossicle is asymmetric and joint congruity cannot be achieved by fixation, resection is the treatment of choice. With progressive arthritis, arthrodesis may be contemplated 6,7 . Both the posteromedial and posterolateral approaches provide complete exposure of the posterior aspect of the ankle and subtalar joints, if surgical treatment is chosen.…”

Section: E21(4)mentioning

confidence: 99%

“…Since then, to the best of our knowledge, only seven more cases have been described in the medical literature, and all of these cases occurred in adolescents who were between thirteen and eighteen years of age [2][3][4][5][6][7] . Three recent reports utilized a computed tomography (CT) scan for evaluation [5][6][7] , but none outlined the exact three-dimensional anatomy of the ossicle. A detailed follow-up has not been provided on any of the prior patients.…”

mentioning

confidence: 99%

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Talus Bipartitus: A Rare Skeletal Variation

Rammelt

Zwipp

Prescher

2011

The Journal of Bone and Joint Surgery-American Volume

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T alus bipartitus (also known as talus partitus or frontal split) is a rare anatomic variant of the talus, first described by Strehle in 1928 1 . Since then, to the best of our knowledge, only seven more cases have been described in the medical literature, and all of these cases occurred in adolescents who were between thirteen and eighteen years of age 2-7 . Three recent reports utilized a computed tomography (CT) scan for evaluation 5-7 , but none outlined the exact three-dimensional anatomy of the ossicle. A detailed follow-up has not been provided on any of the prior patients.The term talus bipartitus describes a large, separate piece of bone that constitutes about one-third of the posterior aspect of the talar body and is separated from that structure by a frontal split. A talus bipartitus is therefore considerably larger than an os trigonum, which contains part of the lateral tubercle of the posterior process of the talus. The os trigonum is not uncommon, with a calculated prevalence of 7% to 13% 8,9 .Over a period of ten years, we have observed four young adult patients with radiographic findings of talus bipartitus. The clinical and radiographic findings were different in all four cases, and treatment consequently had to be tailored individually.This is the first case series of this rare anatomic variant, and we report for the first time on the three-dimensional appearance of this separate ossicle. An average follow-up of 2.5 years after treatment was obtained. The patients were informed that data concerning the cases would be submitted for publication, and they all consented. Case ReportsC ASE 1. A thirty-one-year-old woman presented with a fourteen-month history of occasional pain in the right ankle. She had a history of repetitive inversion sprains of both ankles during competitive sports during childhood, and the last severe sprain occurred three months prior to presentation. Pain was marked during exercise and had been increasing steadily over the last year. On clinical examination, there was chronic ligamentous laxity in both ankles. Slight edema was noted over the posterolateral aspect of the right ankle, but no pain on palpation could be elicited. Right ankle motion was restricted by 15°as compared with the motion on the left side (10°vs. 15°of dorsiflexion and 40°vs. 50°of plantar flexion), while inversion motion at the right subtalar joint was restricted only by 10°.Standard radiographs showed a bipartite talus with a separate bone on the posteromedial aspect, which appeared displaced (Fig. 1). CT and magnetic resonance imaging (MRI) revealed an accessory bone, approximately one-third the size of the talar dome, that extended into both the ankle and subtalar joints. No signs of osteonecrosis of the talar body or the additional ossicle were detected.A posteromedial approach to the talus was carried out via a longitudinal incision made approximately 4 cm parallel and 1 cm medial to the Achilles tendon. The posterior tibial neurovascular bundle was retracted medially, together with the flexor hallu...

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Section: E21(4)supporting

confidence: 93%

Section: E21(4)mentioning

confidence: 99%

Section: E21(4)mentioning

confidence: 99%

mentioning

confidence: 99%

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Talus Bipartitus: A Rare Skeletal Variation

Rammelt

Zwipp

Prescher

2011

The Journal of Bone and Joint Surgery-American Volume

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“…Dorsal flexion TCR, restr. ROM STJ, pain–4X-ray, arthrographyTB, flattened talar domeBoth joints involved–––Blauth [5]198718FLeftPain during activityRestricted ROM AJNo2X-rayTB, sclerotic, congruent1/3 talar dome, both joints involved–––Griffet [7]200315FLeftIntermittent ankle pain during activityNormalNo1X-ray, MRITB, incongruent fragments both joints, degenerative, aberrant aspect calcaneusPosterior 1/3 of talar bodySubtalar arthrodesisDecrease pain, recurrence after 2 y, conservatively treated2Eichenbaum [14]201018MRightIncreasing hindfoot painFROM TCJ, painful restricted ROM STJNo4X-ray, CTTB, degenerative changes4 × 2 × 1.5 cm, 50% post STJExcision + subtalar arthrodesisPain-free activity116MRightAnkle pain and instabilityIncreased ROM STJ, instabilitySprain1.2X-ray, CT, MRITB, sclerotic irregular margins2.8 × 1.1 × 0.8 cmExcisionPain and instability improved0.5Thiel [8]201012…”

Section: Resultsmentioning

confidence: 99%

Talus bipartitus: a systematic review and report of two cases with arthroscopic treatment

Zwiers

Leeuw

Kerkhoffs

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to provide a literature review on talus bipartitus and to introduce an arthroscopic treatment option.Methods A systematic review of published case reports and small case series was performed. Medline, Embase, CINAHL, Google Scholar and Web of Science databases were searched for relevant publications. In addition, three cases of talus bipartitus treated in our institute were discussed.ResultsEleven articles were identified, reporting on 23 patients, of whom one patient had a bilateral talus bipartitus. Fourteen were males (61%). The median age at presentation was 15.5 years (IQR 14–24.3). In 21 of the symptomatic cases (96%), the patient experienced ankle pain, and 13 had a restricted range of motion (54%). In our institution, two patients were treated arthroscopically and had excellent short- and long-term outcomes.ConclusionTalus bipartitus is a rare anatomical anomaly. Symptoms are characterized by pain and restricted subtalar motion in young patients. Surgical treatment is focused on either fixation or excision of the bony fragment. Our two cases have demonstrated that an arthroscopic approach can be a safe and effective treatment option in patients with a symptomatic talus bipartitus.Level of evidenceIV.

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