A course of nonsurgical therapy is recommended as the initial treatment. Surgical treatment of the symptomatic os trigonum in children. After the foot and ankle are examined, xrays or other imaging tests are often ordered to assist in making the diagnosis. Congenital anatomic anomalies such as a prominent posterior talar process, an os trigonum or a talus bipartitus can facilitate occurrence of the posterior impingement syndrome. An os trigonum is a potential source of posterior ankle pain in dancers, often. Os trigonum surgery is used to remove a painful ostrigonum small bone at the back of the foot. Surgical excision is indicated on failure of nonoperative management. The update textbooks are available for 1987, 1990, 1993 1998, 2001 2008 and 2010 20.
Vaccaro and eli baron, offers a highly visual, stepbystep approach to the latest techniques in the field. Physical therapy rehabilitation of an adolescent pre. An os trigonum is a potential source of posterior ankle pain in dancers, often associated with flexor hallucis longus fhl pathology. An arthroscopic technique has been developed to decrease scarring, diminish surgical morbidity, and promote a faster recovery.
Surgical treatment of the symptomatic os trigonum in. Posterior ankle impingement is a condition where an individual experiences pain at the back of the ankle, due to compression of the bone or soft tissue structures during activities that involve maximal ankle plantarflexion motion. My skill came not from any intrinsic abilities of my own but rather from knowing how things were supposed to be done and what to pay attention to, which this book taught me. One of these techniques is the arthroscopy, which we can use for issues in the back part of the ankle.
Endoscopic resection of a symptomatic os trigonum deepdyve. Pdf the operative management of os trigonum syndrome in. The update textbooks are liberallyillustrated resources filled with the latest information on foot and ankle surgery, and related medical topics. Ankle arthroscopy an overview sciencedirect topics. Clinical professor of surgical anatomy and technique emory university school of medicine attending surgeon piedmont hospital atlanta, georgia john e.
These textbooks parallel the lectures presented at the podiatry institutes yearly seminars. Os tibiale externum accessory navicular os supranaviculare dorsal aspect of navicular os peroneum sesamoid bone in pb tendon os calcaneus secondarius dorsal, anterior process of calc os sustentaculi posterior aspect of sustentaculum tali os trigonum posterior aspect of talus steida process os subtibiale distal to medial malleolus. A novel technique of arthroscopic excision of a symptomatic os. An ankle arthroscopy allows us to heal a painful os trigonum. International advances in foot and ankle surgery pp 273275 cite as. Symptomatic os trigonum may be held responsible for chronic ankle pain in children and adolescents as well as in adults. Expert consult online and print, 1e provides beautiful handdrawn anatomic images along with clear instructions on the performance of each operation. Posterior impingement and os trigonum springerlink. It must be distinguished from other causes of posterolateral ankle pain. A surgeons perspective on total knee surgical technique and. Arthroscopy pics of os trigonum attached by cartilage. In those cases where conservative treatment fails, good results have been obtained by surgical excision of the accessory. Endoscopic os trigonum excision through a posterior approach. Symptomatic os trigonum is a rare condition, well described in adults, that causes chronic ankle pain.
Options for surgical excision include open excision. Options for surgical excision include open excision via a posterolateral or posteromedial approach, subtalar arthroscopy, and posterior. Resection from the distal femur will measure from the depth indicated on the. The os trigonum syndrome refers to symptoms produced by pathology of the lateral tubercle of the posterior talar process. Atlas of surgical techniques in trauma edited by demetrios. Dominic carreira is a leading arthroscopic surgeon focused on hip preservation, foot and ankle surgery, and sports medicine. The object of this book is to present to the student of medicine and the practitioner removed from the schools, a series of dissections demonstrative of the relative anatomy of the principal regions of the human body. Os trigonum syndrome can mimic other conditions such as an achilles tendon injury, ankle sprain, or talus fracture. The os trigonum is an accessory bone with inconstant presence at the posterolateral side of the talus.
Os trigonum, children, posterior ankle impingement, talus ossicle. Initially, my surgeon said that i would be able to walk in a boot around 34 days after surgery. Diagnosis of os trigonum syndrome begins with questions from the doctor about the development of the symptoms. Ankle arthroscopy is usually performed in one of four ways. Surgical approaches to the talus should allow access for fracture fixation, resection of osteophytes, treatment of osteochondral lesions, removal of painful os trigonum, and resection of hindfoot. How would you treat a 22yearold professional ballet. A novel technique of arthroscopic excision of a symptomatic os trigonum. Dpl,t introduction the os trigonum is an anatomical variant of the posterior process of the talus where a secondary center of ossification located within the lateral tubercle fails to fuse with the main body of the talus. If you want advise on a difficult case, you can upload it here. Hip arthroscopy post operative protocols atlanta, georgia.
An ankle arthroscopy allows us to heal a painful os trigonum many ankle problems can be fixed using minimally invasive techniques, affording patients a rapid recovery. The spectct procedure is a promising diagnostic tool for patients with unclear. This is a highly valuable, visual, and very practical guide in acute care and trauma surgery. Os trigonum and posterior talar process injuries are common in sports, especially soccer. It appears between the ages of eight and 11 years as a nucleus of secondary ossification that generally fuses in less than one year. Christopher corwin, dpm says surgical excision, when properly indicated, addresses the cause of os trigonum pain, offers a lower risk of recurrence and facilitates a quick recovery and return to activity. Athletes may also experience os trigonum syndrome due to pushoff maneuvers i. Surgical approaches to the talus should allow access for fracture fixation, resection of osteophytes, treatment of osteochondral lesions, removal of painful os trigonum. The image below is that of an intraoperative image under arthroscopy of a symptomatic os trigonum indicated by metal probe.
Surgical treatment for posteromedial talar process fractures. The purpose of this study was to describe our technique and results of arthroscopic resection of a symptomatic os trigonum via two posterior portals in 10 cases. Pdf on jun 28, 2019, karim mahmoud and others published the operative management of os. Suture technique and closure instrumentation the latitude surgical technique has been developed in conjunction with. The full text of this article is available in pdf format. Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome in an athletic population. Os trigonum syndrome occurs due to repetitive, forceful plantarflexion or pointing. The method of choice is a surgeons preference, while taking into account specific. Excision of os trigonum, operative techniques in orthopaedics. The ostrigonum is an accessory extra bone that sometimes develops behind the talus ankle bone during adolescence. Distal femoral resection ensure there is contact between the valgus alignment guide and the distal femur. I am still on crutches and keep trying each day to get my boot on and it hasnt been possible. A novel technique of triplane tarsometatarsal tmt joint corrective arthrodesis in hallux valgus.
A surgeons perspective on total knee surgical technique and the intuition instruments david fisher, md director total joint service at indianapolis orthopaedic hospital instrumentation overview the attune knee intuition instruments were designed to allow surgeons to perform precise total knee arthroplasty tka. The patient is placed in the lateral decubitis position with the operative extremity draped free. Pain can be caused by disruption of the cartilaginous synchondrosis between the os trigonum and the lateral talar tubercle as a result of repetitive microtrauma and chronic inflammation. The os trigonum is the second most common accessory bone in the foot. Request pdf posterior impingement and os trigonum posterior ankle impingement pai is, by definition, a syndrome based on clinical diagnosis. The posterolateral surgical approach seems to be the most frequently used 7, 9. To date there are no reported cases of successfully managed symptomatic os trigonum in the children population. Asymptomatic os trigonum rarely requires treatment. Novel imaging methods and analysis tools in orthopaedics. Not many people have this extra bone, and many of those who do dont k. Eleven patients were retrospectively evaluated after removal of the os trigonum after a mean followup of 35 months. Os trigonum syndrome is the most common cause of posterior ankle impingement. Surgical treatment for posteromedial talar process fractures g model fas 99 no. Open excision of a painful os trigonum can be associated with prolonged recovery.
Jan 01, 2004 os trigonum impingement is a cause of posterior ankle pain in ballet dancers and other athletes who forcibly point their feet. I had surgery for os trigonum almost three weeks ago. Recovery and walking after os trigonum surgery medhelp. Posterior ankle impingement is a condition characterised by tissue damage at the back of the ankle joint due to compression of these tissues during maximal ankle plantarflexion figure 2. Also known as ankle impingement, posterior impingement syndrome, posterior impingement of the ankle, os trigonum syndrome what is posterior ankle impingement. Vaccaro md phd facs author focusing solely on mustknow procedures, operative techniques. Horibe s, kita k, natsuume t, hamada m, mae t, shino k. Between 1999 and 2005 we treated 10 patients with endoscopic resection of a symptomatic os trigonum. The image below is after removal of the os trigonum and now you can clearly visualize the posterior facet of the subtalar joint with healthy cartilage.
Surgical technique local, general, spinal or epidural anaesthesia can be used for this procedure. Ice is applied for 20minute periods 34 times per day. An os trigonum is a potential source of posterior ankle pain in dancers, often associated with. Curbside consultation how would you treat a 22yearold professional ballet dancer with an os trigonum and fluid around her flexor hallucis longus tendon sheath seen. This commonly affects dancers, especially those assuming the extreme plantarflexed position that pointe work requires. For endoscopic treatment of os trigonum, the standard 2 portal hindfoot approach is used. Nov 01, 2006 endoscopic resection of a symptomatic os trigonum endoscopic resection of a symptomatic os trigonum jerosch, joerg.
Arthroscopic excision of the os trigonum led to direct relief of the symptoms. The current literature focuses on general guidelines. Endoscopic resection of a symptomatic os trigonum springerlink. The results of the present study demonstrate that the endoscopic excision of symptomatic os trigonum using a 2portal technique after failure of conservative treatment is characterized by. Surgical treatment of the symptomatic os trigonum in children em. I found basic surgical techniques so helpful that ive recommended it highly and gifted it to other med students. The periloc vlp variableangle locked plating system combines the benefits of both. Skandalakis, md, phd, facs chris carlos distinguished professor of surgical anatomy and technique director, centers for surgical anatomy and technique professor of surgery emory university school.