Astragalectomy

The Astragalektomie , also called Talektomie is the complete surgical removal of the talus ( astragalus , med. Talus ). Overall, the astragalectomy is a very rarely used procedure. Indications are e.g. B .:

• Recurrence of a clubfoot : the improved primary therapy has made the procedure significantly less frequent. Recurrences are more common in the syndromes underlying clubfoot, such as meningomyelocele . The talectomy is often combined with a subtractive wedge osteotomy of the cuboid bone ( os cuboideum ) to compensate for the often severe adduction deformity . The procedure is usually performed through an anterolateral approach. The heel bone is then fixed in the ankle joint with K-wires and a cast immobilization usually takes about six weeks. Instead of a talectomy, however, an extensive radical soft tissue release posterior, lateral and medial is often recommended with simultaneous correction of the rotational deformity of the talus and calcaneus, so that talectomy has become very rare.
• Tumors in the talus : Tumors in the talus are very rare. In the case of malignant tumors, a lower leg amputation is usually performed . A talectomy is particularly suitable for low-grade malignant tumors such as chondrosarcoma or for recurrent and locally invasive benign tumors such as chondroblastoma or osteoblastoma .
• Rearfoot amputation according to Boyd and Pirogoff : In the case of an amputation in the Chopart joint, all foot extensors are lost, whereby the force of the triceps surae muscle usuallycreatesa strong equinus foot position and thus a load on the talus head and the scar area, which is not very soft tissue, usually occurs is not toled off. In this case, in addition to alternative procedures such as the supramalleolar amputation according to Syme or a talocalcanic corrective arthrodesis, the procedure according to Boyd and Pirogoff is available. The talus is completely removed via a ventral access, as is the malleoli. The articular surfaces of the tibia and calcaneus areresectedwith a horizontal osteotomy and the calcaneus is advanced about 10-15 mm and rounded in the plantar-ventral area. An Achilles tendon lengthening is usually no longer necessary due to the talectomy. The osteosynthesis is usually carried out using two cannulated crossed screws or an external fixator . This amputation of the hindfoot results in a stump shortening of 3 to 4 cm, but the heel is able to bear the load.
• after multifragmentary (crush) fractures or post-traumatic osteomyelitis of the talus. The results are rather poor, which is why primary astragalectomy is rarely performed, especially after crush fractures.

The main disadvantages of astragalectomy are the shortening of the foot in the heel area, the resulting changes in the statics of the foot and the often developing osteoarthritis between the incongruent articular surfaces of the heel bone and the shin bone. Often there is also instability and weakness of the rear foot. Sometimes it is suggested to perform a calcaneotibial arthrodesis directly or to extend this to the entire lower ankle joint including the cuboid and navicular bone . Opportunities to compensate for the loss of height resulting from the removal of the talus arise through the displacement of a ventral bone chip from the tibia or with the help of callus distraction with an external fixator .

literature

1. ↑ LS Dias: Foot Deformities in Myelomeningocele. In: J. Duparc: Surgical Techniques in Orthopedics and Traumatology. Volume 8: lower leg, ankle and foot. Urban & Fischer publishing house, Munich 2005, ISBN 3-437-22576-6 .
2. ^ R. Capanna, T. De Biase: Preservation of limbs in tumors of the lower leg and foot. In: J. Duparc: Surgical Techniques in Orthopedics and Traumatology. Volume 8: lower leg, ankle and foot. Urban & Fischer publishing house, Munich 2005, ISBN 3-437-22576-6 .
3. ↑ René Baumgartner, Pierre Botta: Amputation and prosthesis supply of the lower extremity . Enke-Verlag, Stuttgart 1995, ISBN 3-432-97502-3 .
4. ↑ E. Espinar Salom: talar fractures. In: J. Duparc: Surgical Techniques in Orthopedics and Traumatology: Volume 8: Lower leg, ankle and foot. Urban & Fischer publishing house, Munich 2005, ISBN 3-437-22576-6 .

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