scholarly journals Chronic Fracture of the Posteromedial Tubercle of the Talus Masquerading as Os Trigonum Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Thananjeyen Srirangarajan ◽  
Ali Abbasian
Keyword(s):  
Surgical Technique ◽  
Clinical Syndrome ◽  
Senior Author ◽  
Posterior Aspect ◽  
Os Trigonum ◽  
Radiological Features ◽  
Safe Surgery ◽  
Posterior Ankle Impingement ◽  
Fracture Nonunion ◽  
Accessory Ossicle

Posterior ankle impingement syndrome (PAIS) can be caused by osseous pathology from the posterior aspect of the talus. The commonest cause is an os trigonum, an accessory ossicle arising from the lateral tubercle of the posterior talus. We have observed cases where the osseous impingement is due to a chronic fracture nonunion of the medial tubercle of the posterior talus with unique symptoms, differentiating this clinical syndrome from the more common os trigonum syndrome. These can be readily overlooked on imaging and confused with an often coexisting os trigonum. Awareness of these lesions is paramount to ensure appropriate management and safe surgery. We describe a series of patients presenting to the senior author with this clinical syndrome, discuss its unique clinical and radiological features, and describe our surgical technique.

Os Trigonum Syndrome or Posterior Ankle Impingement (PAI)

2014 ◽  
Vol 07 (01) ◽  
pp. 94-95
Author(s):  
Pornthep Mamanee ◽  
Nathapon Chantaraseno ◽  
Somsak Geraplangsub
Keyword(s):  
Os Trigonum ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Endoscopic Repair of Posterior Ankle Impingement Syndrome Due to Os Trigonum in Soccer Players

2014 ◽  
Vol 36 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Víctor López Valerio ◽  
Roberto Seijas ◽  
Pedro Alvarez ◽  
Oscar Ares ◽  
Gilbert Steinbacher ◽  
...  
Keyword(s):  
Impingement Syndrome ◽  
Soccer Players ◽  
Endoscopic Repair ◽  
Os Trigonum ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Augmentation Mastopexy With Surgical Excision of the Lower Pole to Avoid Waterfall Deformity: A Surgical Technique and Nipple Areolar Complex Case Series

2020 ◽  
pp. 229255032093366
Author(s):  
Colin P. White ◽  
Brian D. Peterson
Keyword(s):  
Surgical Technique ◽  
Breast Augmentation ◽  
Capsular Contracture ◽  
Case Series ◽  
Senior Author ◽  
Complex Case ◽  
Silicone Implants ◽  
Lower Pole ◽  
Areolar Complex ◽  
Augmentation Mastopexy

Purpose of this article is to demonstrate a way of avoiding the waterfall deformity in augmentation mastopexy patients. We will show a case series of results and explain how this technique gives satisfying aesthetic results for patients seeking breast augmentation who also require mastopexy. We will show how addressing the breast parenchyma on the lower pole via direct excision can give reliable results and avoids the waterfall deformity. The surgical technique used by the senior author combines the principles of breast augmentation, mastopexy, and breast reduction. We apply these principles during the initial single operation. Our goal is to achieve the best anatomical results for the patient. We describe 1538 consecutive patients whom underwent single-stage breast augmentation with mastopexy. All implants were submuscular with 12% being saline and 88% were silicone implants. Vertical mastopexies were performed in 8% and wise pattern incisions were used in 92%. There were no life-threatening complications such as deep vein thrombosis, pulmonary embolism, and so on. Tissue-related complications included wound infection (1%) and hematomas (1%). Implant-related complications included malposition or implant displacement 9% and capsular contracture 1%. Aesthetic complications included dystopia of NAC (4%) and volume asymmetries (10%). Revision surgery was tissue related (2%), implant related (3%), and aesthetic related (10%). There were no cases of waterfall deformity seen in the cohort. In conclusion, we believe that the technique detailed here is easy to do, uses principles already known of breast augmentation and reduction and gives consistent results with low reoperation rates.

scholarly journals Autologous cervical fascia duraplasty in 123 children and adults with Chiari malformation type I: surgical technique and complications

2018 ◽  
Vol 22 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Brian J. Dlouhy ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Aseptic Meningitis ◽  
Chiari Malformation ◽  
Senior Author ◽  
Csf Leak ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Fascia Graft ◽  
Prospective Database

OBJECTTechniques for combined extradural and intradural decompression with expansile duraplasty for Chiari malformation type I (CM-I) have been well described, with various allogenic and autologous materials used for duraplasty. However, the approach and surgical technique used for duraplasty in our treatment of CM-I and developed by the senior author in the 1990s has not been described.METHODSA prospective database was initiated in March 2003 to denote the use of cervical fascia for duraplasty and incorporate an ongoing detailed record of complications during the surgical treatment of children and adults with CM-I with and without syringomyelia. A total of 389 surgeries for CM-I were performed on 379 patients from March 2003 to June 2016. A total of 123 posterior procedures were performed on 123 patients in which both a posterior fossa extradural and intradural decompression with duraplasty (extra-intradural) was performed. In this paper the authors describe the surgical technique for harvesting and using cervical fascia for duraplasty in the surgical treatment of CM-I and analyze and discuss complications from a prospective database spanning 2003–2016.RESULTSThe authors found that cervical fascia can be harvested in patients of all ages (2–61 years old) without difficulty, and it provides a good substitute for dura in creating an expansile duraplasty in patients with CM-I. Cervical fascia is an elastic-like material with a consistency that allows for a strong watertight closure. Harvesting the cervical fascia graft does not require any further extension of the incision superiorly or inferiorly to obtain the graft. Complications were uncommon in this study of 123 children and adults. The risk of any type of complication (aseptic meningitis, CSF leak, pseudomeningocele, infection, development of hydrocephalus, and need for ventriculoperitoneal shunt) for the 78 patients in the pediatric age group was 0%. The risk of complication in the adult group was 6.7% (1 patient with aseptic meningitis and 2 patients with CSF leak).CONCLUSIONSAutologous cervical fascia is easy to obtain in patients of all ages and provides an effective material for duraplasty in the treatment of CM-I. Complications from the combination of both an extradural and intradural decompression with autologous cervical fascia duraplasty are uncommon.

Endoscopic Versus Open Excision of Os Trigonum for the Treatment of Posterior Ankle Impingement Syndrome in an Athletic Population: A Randomized Controlled Study With 5-Year Follow-up

2017 ◽  
Vol 45 (6) ◽  
pp. 1388-1394 ◽  
Author(s):  
Dimitrios Georgiannos ◽  
Ilias Bisbinas
Keyword(s):  
Impingement Syndrome ◽  
Foot And Ankle ◽  
Open Procedure ◽  
Os Trigonum ◽  
Athletic Population ◽  
Randomized Controlled ◽  
Posterior Ankle Impingement ◽  
Group A ◽  
Group B ◽  
Open Excision

Background: Open surgical excision of the os trigonum has been the traditional treatment for posterior ankle impingement syndrome (PAIS). However, the endoscopic excision has recently become quite popular. Purpose/Hypothesis: The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in an athletic population. It was hypothesized that the endoscopic technique would be superior to the open technique regarding functional outcomes, pain, and time to return to training and the previous sports level. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision; 26 athletes had an open procedure (group A) and 26 had an endoscopic procedure (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and the Visual Analog Score–Foot and Ankle (VAS-FA) were obtained, and the time to return to training and to previous sports level was recorded. Results: Patients in group B appeared to have significant improvement of AOFAS hindfoot score compared with those in group A ( P < .05), whereas no statistical significance was found for the postoperative VAS-FA scores between the 2 groups. The mean ± SD time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B ( P < .001). The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B ( P < .001). The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (1 case). Conclusion: Both the open procedure and the endoscopic approach yielded acceptable outcomes in terms of function and pain. However, complication rates were remarkably lower with endoscopic treatment, and the time to return to full activities was much shorter. Endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who require early return to their previous sports level.

Posterior Ankle Impingement

1994 ◽  
Vol 15 (1) ◽  
pp. 2-8 ◽  
Author(s):  
Mark Raymond Hedrick ◽  
Angus Murdoch McBryde
Keyword(s):  
Plantar Flexion ◽  
Nonoperative Treatment ◽  
Os Trigonum ◽  
Posterior Process ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement ◽  
Lost To Follow Up ◽  
Operative Excision

Thirty cases of posterior ankle impingement in 28 patients were treated over a 10-year period (1982–1992). All conditions were caused by forced plantar flexion. An os trigonum or posterior process fracture was demonstrated radiographically in 63% of these cases, and an intact posterior process was demonstrated in 33%. Ten cases were lost to follow-up. Of the remaining 20 cases, in 18 patients 12 (60%) improved with nonoperative treatment; 8 (40%) required operative excision. The results were good to excellent in 7 patients and fair in 1 patient. Operative excision for the treatment of recalcitrant posterior ankle impingement can relieve symptoms and allow a return to full preinjury activities.

scholarly journals The Anatomical Variations of the Posterolateral Tubercle of Talus in Patients with Posterior Ankle Impingement Syndrome

2021 ◽  
Author(s):  
Heba Kalbouneh ◽  
Mohammad Alsalem ◽  
Maysoon Bani Hani ◽  
Hamzeh Alhusamiah ◽  
Yazan Momani ◽  
...  
Keyword(s):  
Anatomical Variations ◽  
Ct Imaging ◽  
Impingement Syndrome ◽  
Common Variant ◽  
Ct Scans ◽  
Os Trigonum ◽  
Anatomical Variants ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Abstract Background: The most important anatomical variations of the posterolateral talar tubercle that can predispose patients to development of posterior ankle impingement syndrome (PAIS) are an os trigonum and Stieda process. The aim of this study was to elucidate the prevalence of different anatomical variants of posterolateral talar tubercle on CT imaging, their prevalence in patients with PAIS, and to evaluate the risk posed by these anatomical variants to PAIS. Methods: 1478 ankle CT scans were retrospectively reviewed for the different anatomical variants of the lateral talar tubercle, the type and size of os trigonum. In addition, these anatomical differences were assessed in a subgroup of patients with PAIS. Results: Normal sized lateral tubercle was found in 46.1%, Stieda’s process in 26.1%, os trigonum in 20.5% and almost absent tubercle in 7.3%. A statistically higher prevalence of Stieda’s process was found in males while os trigonum was higher in females (p<0.05). In patients with PAIS, the most common variant was os trigonum (48.8%), followed by Stieda process (34.1%). Patients with Stieda process were 1.5 times more likely to have PAIS, and patients with os trigonum were 4.4 times more likely to have PAIS. PAIS was observed in 20.8% of patients with os trigonum. Fused forms of os trigonum (by cartilage) and sizes larger than 1cm were associated with a higher risk of occurrence of PAIS (OR 2.10 and OR 1.96 respectively)(p<0.05). Conclusion: Patients with os trigonum, followed by Stieda process were more likely to have PAIS compared to other anatomical variants of lateral talar tubercle.

scholarly journals Radiological study of Os trigonum and its clinical significance

2021 ◽  
Vol 12 (12) ◽  
pp. 173-176
Author(s):  
Mallikarjun Adibatti ◽  
Muthiah Pitchandi ◽  
V Bhuvaneswari
Keyword(s):  
Correct Diagnosis ◽  
Distal Tibia ◽  
Causative Factor ◽  
Ossification Center ◽  
Flexor Hallucis Longus ◽  
Ankle Pain ◽  
Posterior Aspect ◽  
Os Trigonum ◽  
Orthopedic Surgeons ◽  
Secondary Ossification Center

Background: Os trigonum (OST) is commonly located on the posterior aspect of the talus. It occurs as a result of secondary ossification center failing to fuse with the lateral tubercle of the posterior process of the talus; its incidence varies between 2 and 25%, and is more often bilateral. It occurs as an intra-articular Os, which is most often securely rooted to the lateral tubercle of the talus by a fibrocartilaginous synchondrosis. Aims and Objective: To determine the incidence, morphology, and distribution of Os Trigonum (OST). Materials and Methods: Retrospective 500 lateral foot radiographs view were studied to determine the incidence, morphology, and distribution of OST. Results: Incidence of OST in the present study was 6.6%, with predominantly round or ovoid in shape. OST was located on the posterolateral aspect of the talus. Conclusion: OST can be one of the causative factor responsible for Flexor hallucis longus tendonitis, OST syndrome, which occur in plantarflexion of the ankle, leading to compression of the OST between the distal tibia and the calcaneus. Hence, knowledge regarding the incidence, morphology, and distribution of OST is important for the radiologist, orthopedic surgeons to arrive at a correct diagnosis, which aids in the management of cases presenting with complaints of posterior ankle pain.

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