Studies Of Talus And Its Adjacent Structures On The Anatomy And Clinical Application

Objective: Based on the anatomy study of the talus and its adjacent structures, itexplains the mechanism of talus injury. Surgical approach of talus neck fracture and the way ofinternal fixation, are carefully discussed. Provide anatomical basis for the prevention andtreatment of talus avascular necrosis after fracture.Methods: The experiment specimens are25fresh adult cadavers provided byDepartment of Anatomy of Bengbu Medical College, including16male cadavers at theaverage age of43.1years old and average height of174.2cm and other9female at theage of37.5years old and height of160.6cm. All specimens are proved to have no footmalformation, tumor and bone lesions.①With colored latex, ammonia and bariumsulfate mixed perfusion specimens after digital gastrointestinal machine X-ray, spiralCT scanning and3D reconstruction of talus, peripheral vascular imaging observation.And then the anatomical dissection was performed to observe its adjacent structures.②DSA is operated on10adult volunteers’ ankles DSA and further observation on theperipheral vascular imaging of talus has been conducted.③Talus are anatomized tomeasure the length, width, height of talus, the width before and after the trochlea oftalus, and the height of trochlea with precision vernier caliper to only two decimalplaces.④In21patients’operation cases of talar neck fracture, the treatment of openreduction and two cannulated screw fixation are adopted based on the anatomicalresults.Results:①The blood supply of the talus: vascular anastomosis is found between theanterior tibial artery, posterior tibial artery and the peroneal artery, which forms corresponding region to provide nutrition for the talus.②The adjacent structures ofthe talus: medial malleolus, lateral malleolus, and the subtalar calcaneal tubercle formthe irregular quadrilateral around talus. Surrounding vital structures are: the posteriortibial artery, nerve behind the talus, tibial nerve. Tibial nerves go from the leg of themen behind the dark line in the medial malleolus and the medial calcaneal tubercle intothe midpoint of sudden foot, the lateral nerves. Achilles tendon and a lateral groovebetween the experimentally measured tendon groove width34.81±4.12mm, the tendongroove is no major blood vessels, nerves, tendons through. Talus can be divided intothree different parts of head, neck and body,60to70%of its surface covered bycartilage, muscles attached to its free, seven with the surrounding articular surface boneformation adjacent joints.③Measurement data with the parameters of talus are asfollows: Length of the talus55.61±3.07mm, Width of the talus42.32±3.19mm,Height of the talus32.42±3.28mm, Height of the talar’s trochlea10.02±1.03mm, Backwidth of the talar’s trochlea22.57±2.13mm, Front width of the talar’s trochlea32.05±2.56mm.④All cases were discharged from hospital on time without woundinfection, disunion and skin complication. All patients wound healing in12~14days,and the clinical results were excellent in6cases, good in8cases and common in1caseaccording to Hawkins standard.Conclusions:①The talus itself has no independent nourishing blood vessels butsurrounding ligaments and joint capsule distributed around talus to supply blood.Surrounding blood vessels of talus provide nutrition for talus’ corresponding regions,mainly from the anterior tibial artery, posterior tibial artery, peroneal artery and itsbranches issued by them.②Talus, the bone in its irregular shape, can be found in thetibia and fibula, foot navicular and calcaneus. While talus has a narrow front and wideend, trochlea talus’ front part is wide and the end is narrow. When ankle dorsiflexionand ankle plantar flexion occur, the surface is still with the ankle point contact, so that uneven force on both sides increasing the instability of the ankle joint. Talus fractureand dislocation can easily cause damaged blood vessels into the talus. Local soft tissuecontusion, swelling, and the fracture-dislocation can also lead to blocked blood vessels,often causing complications such as avascular necrosis of the talus. Therefore, vesselsshould be protected in the treatment of talus fractures.③With its unique anatomicalfeatures,which the anatomy and blood supply of the talus are special, it is found thatanatomic reduction and stable internal fixation has good clinical curative effect whentreatment conducted from ankles’ anterolateral, anteromedial or lateral wound partsaccording to the different fracture site and shift condition.