Edema of the talus
Damage to the talus. Classification of injuries of the talus
Talus Is the main bone of the skeleton of the foot, isit is between the tibial, navicular and heel bones. The talus bone on most of its surface (two-thirds) is covered with articular cartilage, resulting in an opinion about poor blood supply to it. Due to the peculiarities of blood circulation, there is a threat of development of general or partial necrosis of the talus and, accordingly, disability.
Unlike the generally accepted opinion of J. Schatzker (1994) believes that the talus bone is blood supply enough. According to him, the blood supply to the talus is carried out by the branches of the posterior tibial artery (the artery of the talus canal and the branch of the deltoid artery), the anterior tibial artery (artery of the sulcus of the talus and the upper-cervical arteries) and the peroneal artery. The main arteries penetrate the bone posteriorly from the collar of the talus, so that isolated fractures that do not pass to the body, as a rule, do not lead to a disturbance of blood circulation. Important importance is attached to the deltoid artery, which ensures the vitality of the body of the talus.
The cause of a fracture or dislocation of the talus there is a fall from height to foot in the stateextreme supination, pronation or back bending. These fractures are often combined with other injuries. Associated fractures of the ankle are recorded in 15% of patients, fractures of the calcaneus bone - in 10%, foot bones - in 15%, open injuries - in 20% of the affected.
Widely applied classification of fractures of the talus. developed by Coltart (1952), who proposed to distinguish fractures of the body of the talus and fractures of the neck of the talus:
type I - fractures of the neck of the talus without bias;
type II - fractures of the neck of the talus with displacement with subluxation in the subtalar joint;
type III - fractures of the neck of the talus with a dislocation of her body;
- subluxation in the subtalar joint;
- complete dislocation of the talus bone.
The most common fractures of the cervix. For types of fractures of neck I and II of significantthere is no disturbance of blood circulation, therefore the risk of necrosis of the talus is negligible. Prognostically doubtful about necrosis of the talus is Type III, because dislocation in the upper and lower ankle joint disturbs the blood supply in the sinus and dorsal part of the neck of the talus.
As a rule, there is a painful syndrome. edema, deformity, the severity of which dependsof the degree of severity of the fracture. Movement in the ankle is either broken or impossible. With secondary damage to soft tissues, a violation of peripheral sensitivity or motility is most often observed. This is due to traction damage to the nerve or infringement of the tendons.
For diagnostics recommend an antero-back and lateral radiographs and X-rays in special oblique projections. Tomograms are useful for revealing the fragmented nature of neck and body fractures, as well as discongruence in the subtalar joint. Computer tomograms of the foot provide an excellent diagnosis of the nature of the fracture and the degree of bone fragmentation. A thorough examination reveals the features of the damage. The findings should be the logical basis for the proposed treatment.