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Quantitative Assessment of the Vascularity of the Talus with Gadolinium-Enhanced Magnetic Resonance Imaging
Anna N. Miller, MD1; Mark L. Prasarn, MD2; Jonathan P. Dyke, PhD3; David L. Helfet, MD4; Dean G. Lorich, MD4
1 Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA 98104. E-mail address: anmiller@gmail.com
2 University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642
3 Citigroup Biomedical Imaging Center, Weill Cornell Medical College, 516 East 72nd Street, New York, NY 10021
4 Orthopaedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Synthes. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Hospital for Special Surgery and Citigroup Biomedical Imaging Center at Weill Cornell Medical College, New York, NY

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jun 15;93(12):1116-1121. doi: 10.2106/JBJS.J.00693
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Abstract

Background: 

The purpose of this study was to quantify the various arterial contributions to the talus with use of magnetic resonance imaging (MRI).

Methods: 

The arterial anatomy of the talus was studied in ten pairs of fresh-frozen cadaver limbs with use of gadolinium-enhanced MRI in addition to gross dissection following latex injection. MRI proved useful to confirm the presence of specific arterial branches in situ as well as to demonstrate the rich anastomosis network in and around the talus. We further examined the MRI studies to delineate the quantitative contribution of each of the three main arteries to the talus and to each quadrant of the talus (anteromedial [0], anterolateral [1], posterolateral [2], and posteromedial [3]).

Results: 

The peroneal artery contributed 16.9% of the blood supply to the talus; the anterior tibial artery, 36.2%; and the posterior tibial artery, 47.0%. The contribution of the anterior tibial artery was greatest in quadrant 0, whereas the contribution of the posterior tibial artery was greatest in quadrants 1, 2, and 3. The peroneal artery did not make the greatest contribution in any quadrant.

Conclusions: 

In contrast to the findings in previous studies, we found that a substantial portion of the talar blood supply can enter posteriorly, which helps to explain why all talar neck fractures do not result in osteonecrosis. This finding, along with a very rich and redundant intraosseous pattern of anastomosis with contributions from all three vessels in each quadrant of the talus, may explain the low occurrence of osteonecrosis in association with talar neck fractures.

Clinical Relevance: 

Blood supply to the talus may be maintained via vessels entering from the posterior aspect after a fracture of the talar neck. A thorough understanding of the anatomy and careful surgical dissection are essential to prevent unnecessary additional vascular insult during the treatment of fractures of the talus.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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