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Osteonecrosis of the Lateral Aspect of the Talar Dome After Triple Arthrodesis. A Report of three Cases*
CHRISTOPHER K. JONES, M.D.†; JAMES A. NUNLEY, M.D.†, DURHAM, NORTH CAROLINA
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Investigation performed at the Division of Orthopaedic Surgery, Duke University Medical Center, Durham
J Bone Joint Surg Am, 1999 Aug 01;81(8):1165-69
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Extract

Disruption of the blood supply to the talar dome leads to bone infarction that may be segmental or involve the entire dome. There is ischemic death of the cellular constituents in the infarcted area, which leads to osteonecrosis. Histologically, this process is recognized on the basis of the disappearance of osteocytes from within the lacunae. Radiographs give the appearance of osteoporosis of the surrounding bone due to hyperemia, whereas the infarcted bone retains its density. Disruption of the blood supply can be secondary to trauma6,12,14,20, external compression, or intraluminal obstruction1,3. Disruption due to external compression can occur when a space-occupying lesion physically compresses the arterial supply and inhibits blood flow. Intraluminal obstruction occurs when there is an intravascular process that interrupts blood flow. Fat emboli can occlude blood vessels; this has been seen in histological studies performed on specimens of osteonecrotic femoral heads3.
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    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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