Talus fracture

The talus is a turtle-shaped small bone that sits between the heel bone calcaneus and the two bones of the lower leg, the tibia and fibula. Over half of the talus is covered with cartilage. The talus is an important connector between the foot and the leg and the body. It helps to transfer weight and pressure across the ankle joint. Therefore any injury to the talus affects the ankle and the subtalar joints and multiple planes of movement of the foot and ankle are also affected. It is interesting to note that the first series of talus fractures was described in men injured in the British Royal Air Force in early 1900, when the old war planes made crash landings. The term aviators astragalus was used to describe what we now call talus fracture. Typically causes for talus fracture include fall from heights, motor vehicle collisions and injuries of the lower back.

Persons suffering from talus fracture experience acute pain and considerable swelling and tenderness in the affected area. There is inability to bear weight. Often this type of fracture is mistaken for ankle sprain. A physician relies on x rays of the foot and the ankle to ascertain the nature and kind of talus injury. In some cases, if x ray does not reveal the nature of the fracture, a CT scan is requested. Fractures in the talus can occur:

• Through the neck of the talus
  
• Through the dome of the talus
  
• Aviators fracture which occur through the neck of the talus with dislocation of the body of the talus out of the ankle joint.

Fractures of the talus are rare but when they occur they are highly complicated. Since talus has no muscle attachment and peculiar blood supply, high morbidity in the form of non-union and mal union can occur. Avascular necrosis, which means partial death of the bone, leading to a painful arthrosis condition is another common complication.

Immediate first aid has to be rendered to patients from talus fractures. A well-padded splint around the back of the foot and leg from the toe to the upper calf is placed. Foot must be elevated to the level of the heart to prevent further edema. Ice packs can be applied every twenty minutes till the physician arrives. Care should be taken not to put weight on the injured foot. Untreated talus fractures can create problems later. The foot may get impaired and the patient is at risk of developing arthritis and chronic pain. The bone may even collapse in certain cases.

Often talus fractures require surgery to minimize the complications from arising later. The surgeon realigns the bones surgically and uses metal screws to hold the pieces in place. Small fragments of bone can be removed by bone grafts which are used to restore the structural integrity of the joint.

Even after a good correction surgery, there is always the danger of deformity, arthritis and other conditions like lack of blood supply to the talus bones. The ability of the ankle to move can be affected if ankle arthritis occurs. Subtalar arthritis that is arthritis in the subtalar joint beneath the talus bone is another complication. Deformity of the foot is another problem of talus fracture. When the fracture is fixed, it becomes difficult to reposition the bone correctly and deformity may occur.

Scaphoid bone fracture

Scaphoid bone fracture occurs normally when a person falls on an outstretched hand. With the palm bearing the weight, there is the risk of forearm bone (distal radius) fracture too. The symptoms are pain and swelling in the wrist. If there is no deformity of the wrist, people generally tend to think that it is only a sprain. If symptoms like pain and swelling on the thumb side of the wrist after a fall last a few days, then it is advisable to see a doctor and get treated for the broken bone. Located where the wrist bends towards the thumb, Scaphoid bone is at the base of the small depression made by the thumb tendons. When the Scaphoid is injured, pain or tenderness is associated with it.

Consult a doctor if the pain on the thumb side of the wrist persists even after few days of medication. The orthopaedist will prefer to take X-rays, but sometimes a broken bone of this type does not show up clearly on an X-ray. A MRI helps in confirming scaphoid bone fracture. Minimize the risk of broken bones around the wrist by using wrist guards while performing activities like snowboarding and inline skating.

Depending on the location of the break in the bone, an orthopaedist starts the treatment. If it is broken at the end near the thumb which has good blood supply, healing takes place within a few weeks if it is protected properly. A CT scan or X-ray will confirm that the fracture has healed. A cast that may or may not include the thumb is a good option to heal this kind of Scaphoid fracture. If the Scaphoid is broken in the middle or at the proximal pole which does not have good blood supply, it is difficult to heal. The doctor places a cast that includes the thumb and index finger and extends up to the elbow.

In some cases, wrist arthritis may develop following a Scaphoid fracture. This may be due to the cartilage injury at the time of the fall or accident, or due to wear and tear from changes in the alignment of the joints. It may also be due to a cut off in blood circulation. Deterioration of the bone (avascular necrosis) at this part will lead to degenerative arthritis. Physiotherapy exercises and special exercises will improve movement and strength of the Scaphoid bones. Stiffness in the wrist and finger is not unusual after this injury.

Arthroplasty

Arthroplasty literally means 'formation of joint'. It refers to the surgical replacement of arthritic or destructive joint with prosthesis. During arthroplasty, the dysfunctional joint is replaced with a better remodeled joint. Osteotomy procedure used to restore or modify joint congruity is also arthroplasty. Although arthroplasty is used for construction of a new movable joint, it cannot be applied to every body joint. Its use, in practice, is confined to the shoulder, elbow, hip, knee, certain joints of the hand, metatarso-phalangeal joints in the foot.

The two main reasons for undergoing arthroplasty are pain in the joints and decreased quality of life. Some common indications for arthroplasty would include advanced osteoarthritis, rheumatoid arthritis with avascular necrosis, congenital dislocation of the hip joint, shallow hip socket, frozen shoulder, loose shoulder, traumatized joint and joint stiffness, un united fractures of the neck of the femur, and for correction of certain types of deformity.

There are three methods in general which are adopted in Arthroplasty: excision arthroplasty, half-joint replacement arthroplasty and total replacement arthroplasty. Each of these methods have their own distinct merits as well as disadvantages and special applications.

In excision arthroplasty both the articular ends of the bones are simply excised. A gap is created between them and this is filled with fibrous tissue, a pad of muscle or other soft tissue which may be sewn in between the bones. This method is applicable to all the joints other than the knee and ankle.

In half-joint replacement arthroplasty, one of the articulating surfaces is removed and this is replaced by a prosthesis of similar shape. The prosthesis is made of metal and rarely silicone rubber. This technique has its application at the hip. It has rather limited use elsewhere in the body.

As for total replacement arthroplasty, both the opposed articulating surfaces are excised and replaced by prosthetic components. Sometimes, in larger joints, one of the components is of metal and the other, a high density polyethylene. Both components are held in place by acrylic 'cement.'

The joint is fully exposed and the damaged bone and cartilage are cut away or reshaped. Prosthesis are inserted after measurements are taken to ensure proper fit. The joints are usually tested before the incision is closed. Arthroplasty is typically followed by several days of hospitalization. Medications are given to relieve the pain and prevent further infections and blood clots. Physical therapy is extensively employed to bring back the joints to near normal functioning. Occupational therapy is also prescribed to enable patient independently cope up with routine activities. Patients resume normal activities after two to three months duration.