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Available online at www.sciencedirect.com

The Foot 18 (2008) 56–58

Case report

Osteochondral fracture of talus treated with bio absorbable pins

Prakash Chandran a,∗, Ravindra P. Kamath b, Aneel Nihal b

a Trauma and Orthopaedics, Arrowe Park Hospital, Wirral, United Kingdomb Department of Trauma and Orthopaedics, Hull Royal Infirmary, Hull, West Yorkshire, United Kingdom

Received 24 September 2007; accepted 24 October 2007

bstract

We report a case of osteochondral fracture of the talus treated by open reduction and internal fixation with bioabsorbable pins. A displacedsteochondral fracture of the lateral aspect of the talar dome measuring 7.5 mm × 3.8 mm × 5 mm was treated by open reduction and fixation

ith bioabsorbable (poly-p-dioxanone) pins. Satisfactory healing of the osteochondral fracture was achieved without any complications and

he patient had good functional outcome. We believe that poly-p-dioxanone pins are a safe and effective option to consider while treatingsteochondral fractures of the talus.ublished by Elsevier Ltd.

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eywords: Osteochondral fracture; Talus; Bioabsorbable pins

. Introduction

Increasing awareness and improved accessibility to imag-ng has lead to increased reporting of osteochondral fracturesf the talus. Osteochondral lesions are relatively common andsually occur as a result of trauma. They often go unrecog-ized and lead to an osteochondral defect that may eventuallyesult in secondary osteoarthrosis. Detection of these lesionsas been aided by CT, MR imaging and bone scan. With lim-ted ability of the hyaline cartilage to repair itself, surgicalntervention is often necessary to create an optimal healingnvironment [2]. The goal of all treatment methods is to pro-ide a stable, congruent joint surface, restore function, andrevent the evolution of osteoarthrosis. Acute osteochondralragments can be replaced and internally fixed [3,6] or theragment arthroscopically excised with curettage and drillingf the surface [8].

Internal fixation devices include metal screws/pins orioabsorbable pins. Metal pins/screws may occasionally need

emoval if there is collapse of the osteochondral fragment,hile such complication could be avoided by the use ofio absorbable pins. However bioabsorbable pins for intraar-

∗ Corresponding author at: 15 Cresswell Close, Callands, Warrington,orth Cheshire WA5 9UA, United Kingdom. Tel.: +44 7919403862.

E-mail address: prakachandran@yahoo.co.uk (P. Chandran).

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958-2592/$ – see front matter. Published by Elsevier Ltd.oi:10.1016/j.foot.2007.10.001

icular use are yet to be widely used. Results indicate thatbsorbable implants are biocompatible and effective in thexation of osteochondral fragments [4].

Though bioabsorbable pins have been used in the treat-ent of various fractures, their use in the treatment of

steochondral fractures of the talus has not been widelyeported. We report a case of osteochondral fracture treateduccessfully with a bio absorbable pin.

. Case report

A 26-year-old joiner tripped over scaffolding at work andell from a height of 5 feet, sustaining injury to his leftnkle. He presented to the accident and emergency depart-ent with a painful bruised ankle and inability to weight

ear. Anterioposterior, lateral and oblique radiographs of thenkle showed an osteochondral fracture of the talar domeFig. 1). CT scan of his ankle showed a displaced osteochon-ral fracture of the lateral aspect of the talar dome measuring.5 mm × 3.8 mm × 5 mm (Fig. 2), no other injuries weredentified. The patient underwent open reduction and internal

xation of this fracture. An anterolateral arthrotomy was per-ormed and the talar dome identified, osteochondral fractureas exposed and defined, the fractured fragment was found

o be displaced and rotated by 180 degrees with the articular

P. Chandran et al. / The Foot 18 (2008) 56–58 57

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Fig. 3. Intra operative picture of the osteochondral fragment following fix-ation with bioabsorbable screws.

Fig. 1. X-ray showing osteochondral fracture on dome of the talus.

urface of the fragment facing the talar dome and the frac-ured surface was facing the tibial plafond. The fragment waseduced anatomically and held in the reduced position withhree 40 mm × 1.3 mm absorbable pins (Orthosorb® bioab-orbable pin) (Fig. 3). Postoperatively the leg was supportedn a below knee plaster cast and was kept nonweight bearingor 6 weeks. Touch weight bearing was allowed at the endf 6 weeks in a below knee removable splint. Full weightearing was allowed at 3 months post-fixation. At the last

ollow up 12 months post-surgery, the patient had no painnd was mobilising full weight bearing, he had 10 degreesf dorsiflexion and 30 degrees of plantar flexion at his ankleoint which was pain free. X-ray and MR scan of his ankle

ig. 2. Computed tomogram showing osteochondral fracture on the domef the talus.

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ig. 4. CT picture of the talus following satisfactory healing of the osteo-hondral fracture.

howed satisfactory healing of the fracture with no evidencef avascular necrosis (Fig. 4).

. Discussion

Early recognition and appropriate treatment of osteo-hondral fractures involving the talus is necessary in ordero produce favourable results [2]. Though osteochondralractures have been satisfactorily treated by excision ofhe osteochondral fragment [8], early treatment with openeduction and internal fixation using a low profile screwr pins may prevent occurrence of secondary osteoarthritis6].

For fixation of the osteochondral fragments, bioabsorbableins are available as an alternate choice to metal fixation. Theradual absorption of these pins allows for optimum transferf support to the bone as the healing of fracture progresses.

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[7] Lavery LA, Peterson JED, Pollack R, Higgins KR. Risk of complications

8 P. Chandran et al. /

hese pins provide the same support as metal fixation for pro-ection against shear and rotational forces, while eliminating

ost of its disadvantages. However, use of bioabsorbablemplants has been reported to be associated with adverse tis-ue reaction [1] which can be mild in the form of painfulrythematous papule, or of medium severity with a sinushat may discharged remnants of the implant for a short timer severe with extensive osteolytic lesions adjacent to themplant tracks with formation of a sterile discharging sinus5].

Bio absorbable pins commonly used in fracture fixationnclude polyglycolide pins (Biofix®), polylactide acid andoly-p-dioxanone (PDS) (Orhosorb®). Studies have demon-trated that absorbable implants are biocompatible and areffective for fixation of osteochondral fragments [4]. Numer-us trials have compared the use of bioabsorbable pins withach other and with metal pins. Lavery et al. [7] comparedolyglycolide pins with poly-p-dioxanone pins in the fixa-ion of the first metatarsal osteotomies and reported moreomplications with polyglycolide pins. Comparing poly-p-ioxanone pins to K wires for fixation following chevronsteotomy, Gill et al. [5] found no difference between themnd concluded that bioabsorbable pins can be reliably usedo fix osteotomies without undue risk of osteolysis and otheromplications.

Lavery et al. [7] compared Biofix, polyglycolide pins andrthosorb, polydioxanon pins, in fixation of first metatarsalsteotomies and complications were more common insteotomies fixed with Biofix compared with Orthosorb.

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ot 18 (2008) 56–58

Bioabsorbable pins have been used in the treatment of var-ous fractures; there is limited literature on its use for intrarticular fractures. We achieved satisfactory healing of thesteochondral fracture of the talus with poly-p-dioxanonePDS) without any complications and the patient had goodunctional outcome. We believe that poly-p-dioxanone pinsre a safe and effective option to consider while fixing osteo-hondral fractures of the talus.

eferences

1] Bostman OM, Pihlajamaki HK. Adverse tissue reactions to bioab-sorbable fixation devices. Clin Orthop Relat Res 2000;371:216–27.

2] Chaney DM, Toups J, Foster J. Osteochondral fractures of the talus. ClinPodiatr Med Surg 2001;18(3):481–93.

3] Farmer JM, Martin DF, Boles CA, Curl WW. Chondral and osteo-chondral injuries. Diagnosis and management. Clin Sports Med2001;20(2):299–320.

4] Fuchs M, Vosshenrich R, Dumont C, Sturmer KM. Reification ofosteochondral fragments using absorbable implants. First results of aretrospective study. Chirurg 2003;74(6):554–61.

5] Gill LH, Martin DF, Coumas JM, Kiebzak GM. Fixation with bioab-sorbable pins in chevron bunionectomy. J Bone Joint Surg Am1997;79(10):1510–8.

6] Jimenez AL, Morgan Jr JH. Talar fractures: three case studies. J AmPodiatr Med Assoc 2001;91(8):415–21.

of first metatarsal head osteotomies with biodegradable pin fixation:biofix versus orthosorb. J Foot Ankle Surg 1994;33(4):334–40.

8] Schuman L, Struijs PA, van Dijk CN. Traumatic osteochondral lesionsof the talar dome. Orthopade 2001;30(1):66–72.