Date: Thu, 12 Feb 2004 12:00:05 +0100

From: Alo Kullerkann

Subject: talar AVN

Dear members,

Please advise on next case:

58 y/o female, had ankle sprain 3 months ago. First avulsion fracture on the tip of fibula was diagnosed and cast was applied for four weeks. After cast removal pain and swelling did not subside.

Now has mild swelling at ankle. Walks with cruches, weight bearing is not possible due to pain.

Some days ago seeked for second opinion.

I think there was a nondisplaced talar neck fracture with complicated by AVN.

Current X-ray shows sclerosis of talar body, destruction at talar dome. MRI shows diffuse swelling in talus (interesting where comes the swelling if there is avascularity?). CT does not surely confirm fracture but shows diffuse osteoporosis in tarsal bones.

• Is it AVN?
• Was there a fracture?
• How would you treat that lady?
• Exfix to decompress tibiotalar joint?
• Cast and non weightbearing, if yes how long?
• No fix, non weightbearing, if yes how long?
• Any other treatment, modalities?

Best regards,

Alo Kullerkann, MD.
Orthopaedic Surgeon
Mustame Hospital, Tallinn
Estonia

Date: Thu, 12 Feb 2004 22:48:41 EST

From: Aobonedoc

I think it was a talar neck fracture. I would try nonweight bearing for several months.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005