Three-dimensional Mapping Analysis of Talus Fractures and Demonstration of Different Surgical Approaches for Talus Fractures

Abstract

Objective: The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures.

Methods: We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure.

Results: Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches.

Conclusion: Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.

Keywords

3D mapping / Heat map / Surface area of the talus / Surgical approach / Talus fracture

References

[1] AdelaarRS. Complex fractures of the talus. Instr Course Lect. 1997;46:323–338.

[2] SautetP, Roussignol X, LoubignacF, RochwergerRA, Pidhorz L, la Société Française de Chirurgie Orthopédique et Traumatologique (SOFCOT). Talar fracture: epidemiology, treatment and results in a multicenter series. Orthop Traumatol Surg Res. 2021;107(6):102835.

[3] BuzaJA, LeuchtP. Fractures of the talus: current concepts and new developments. Foot Ankle Surg. 2018;24(4):282–290.

[4] VallierHA, NorkSE, BenirschkeSK, SangeorzanBJ. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003;85(9):1716–1724.

[5] HawkinsLG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52(5):991–1002.

[6] SneppenO, BuhlO. Fracture of the talus. A study of its genesis and morphology based upon cases with associated ankle fracture. Acta Orthop Scand. 1974;45(2):307–320.

[7] BizC, GolinN, De CiccoM, Maschio N, FantoniI, FrizzieroA, et al. Long-term radiographic and clinical-functional outcomes of isolated, displaced, closed talar neck and body fractures treated by ORIF: the timing of surgical management. BMC Musculoskelet Disord. 2019;20(1):363.

[8] PflügerP, Zyskowski M, WeberA, GleisenbergK, Kirchhoff C, BiberthalerP, et al. Patient reported outcome of 33 operatively treated talar fractures. BMC Musculoskelet Disord. 2021;22(1):698.

[9] GuoX, LiangX, JinJ, ChenJ, LiuJ, ZhaoJ. Evaluation of Sanders type 2 joint depression calcaneal fractures in 197 patients from a single center using three-dimensional mapping. Med Sci Monit. 2021;27:e932748.

[10] HeW, ZhouH, ZhangY, Yu T, XiaJ, ZhaoY. Classification of avulsion fractures of the fifth metatarsal base using three-dimensional CT mapping and anatomical assessment: a retrospective case series study. J Foot Ankle Res.2022;15(1):65.

[11] ZengJ, XuC, XuG, ZhangW, WangD, Li H. Evaluation of ankle fractures in 228 patients from a single center using three-dimensional computed tomography mapping. Front Bioeng Biotechnol. 2022;10:855114.

[12] NozakiS, Watanabe K, KamiyaT, KatayoseM, Ogihara N. Morphological variations of the human talus investigated using three-dimensional geometric morphometrics. Clin Anat. 2021;34(4):536–543.

[13] RushJK, KirkK, KirbyJ, Hsu J. Lateral talar dome access utilizing temporary invasive distraction. Foot Ankle Int. 2010;31(3):236–241.

[14] PatzkowskiJC, KirkKL, OrrJD, Waterman BR, KirbyJM, HsuJR. Quantification of posterior ankle exposure through an achilles tendon-splitting versus posterolateral approach. Foot Ankle Int. 2012;33(10):900–904.

[15] PetersPG, ParksBG, SchonLC. Anterior distal tibia plafondplasty for exposure of the talar dome. Foot Ankle Int. 2012;33(3):231–235.

[16] MagnussonEA, TelferS, JacksonM, Githens MF. Does a medial malleolar osteotomy or posteromedial approach provide greater surgical visualization for the treatment of Talar body fractures? J Bone Joint Surg Am. 2021;103(24):2324–2330.

[17] AltonT, PattonDJ, GeeAO. Classifications in brief: the Hawkins classification for talus fractures. Clinical Orthopaedics and Related Research. 2015;473(9):3046–3049.

[18] VallierHA, Reichard SG, BoydAJ, MooreTA. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014;96(3):192–197.

[19] von WinningD, Lippisch R, PliskeG, AdolfD, Walcher F, PiatekS. Surgical treatment of lateral and posterior process fractures of the talus: mid-term results of 15 cases after 7 years. Foot Ankle Surg. 2020;26(1):71–77.

[20] PereraA, BakerJF, LuiDF, Stephens MM. The management and outcome of lateral process fracture of the talus. Foot Ankle Surg. 2010;16(1):15–20.

[21] WangY, WangZ, ZhuY, FuL, DengX, Chen W, et al. New classification based on CT and its value evaluation for fractures of the lateral process of the talus. J Foot Ankle Surg. 2023;62(4):644–650.

[22] WijersO, Posthuma JJ, De HaasMBJ, HalmJA, Schepers T. Lateral process fracture of the talus: a case series and review of the literature. J Foot Ankle Surg.2020;59(1):136–141.

[23] RomeoNM, Hirschfeld AG, GithensM, BenirschkeSK, Firoozabadi R. Significance of lateral process fractures associated with Talar neck and body fractures. J Orthop Trauma. 2018;32(12):601–606.

[24] EarlyJS. Talus fracture management. Foot Ankle Clin. 2008;13(4):635–657.

[25] SeguraFP, EslavaS. Talar neck fractures: single or double approach? Foot Ankle Clin. 2020;25(4):653–665.

[26] SripanichY, Dekeyser G, SteadmanJ, RungpraiC, HallerJ, SaltzmanCL. Limitations of accessibility of the talar dome with different open surgical approaches. Knee Surg Sports Traumatol Arthrosc. 2021;29(4):1304–1317.

[27] MillerAN, Prasarn ML, DykeJP, HelfetDL, LorichDG. Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am. 2011;93(12):1116–1121.

[28] ShankJR, Benirschke SK, SwordsMP. Treatment of peripheral talus fractures. Foot Ankle Clin. 2017;22(1):181–192.

[29] RomeoNM, Benirschke SK, FiroozabadiR. Technique for open reduction and internal fixation of lateral process talus fractures. J Orthop Trauma. 2020;34(Suppl 1):S9–S13.

[30] VallierHA. Fractures of the talus: state of the art. J Orthop Trauma. 2015;29(9):385–392.

[31] LeeC, BrodkeD, PerduePW, Patel T. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2020;28(20):e878–e887.

[32] GithensM, Tangtiphaiboontana J, CarlockK, CampbellST. Talus fractures: an update on current concepts in surgical management. J Am Acad Orthop Surg.2022;30(15):e1015–e1024.

[33] HegazyMA, KhairyHM, HegazyAA, Sebaei MAEF, SadekSI. Talus bone: normal anatomy, anatomical variations and clinical correlations. Anat Sci Int.2023;98(3):391–406.

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