Assessment of Ankle and Hindfoot Stability and Joint Pressures Using a Human Cadaveric Model of a Large Lateral Talar Process Excision. Issue 11 (March 2015)

• Record Type: Journal Article
• Authors: Sands, Andrew; White, Charles; Blankstein, Michael; Zderic, Ivan; Wahl, Dieter; Ernst, Manuela; Windolf, Markus; Hagen, Jennifer E.; Richards, R. Geoff; Stoffel, Karl; Gueorguiev, Boyko; Agarwal., Suresh
• Is Part Of: Medicine. Volume 94:Issue 11(2015)
• Publication Date: 2015-03
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000000606
• Languages: English
• ISSNs: 0025-7974

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Abstract</title> <p>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.</p> <p>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<sup>3</sup> and 10 cm<sup>3</sup> 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.</p> <p>In comparison to the pre-excision state, no significantly different mediolateral angular change was observed in the subtalar joint after 5 and 10 cm<sup>3</sup> lateral talar process fragment excision in inversion and eversion. With respect to the ankle joint, 10-cm<sup>3</sup> fragment excision produced significantly bigger inversion tibiotalar tilt compared with the pre-excision state, <italic>P</italic> = .04. No significant change of the ankle joint pressure and contact area was detected after 5 and 10-cm<sup>3</sup> excision in comparison with the pre-excison state.</p> <p>An excision of up to 10 cm<sup>3</sup> 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.</p> </sec> </abstract>