Talonavicular joint approach to the talar body: a cadaver study.
BACKGROUND
Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body.


METHODS
Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured.


RESULTS
All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area.


CONCLUSIONS
The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments.


CONCLUSIONS
This study shows that talar dome lesions can be reached with a minimally invasive method.
Afyon Kocatepe Universitesi, Tip Fakultesi Ortopedi ve Travmatoloji AD, Afyon, Turkey. kacako@hotmail.com
Kamil Cagri
KC
Kose
Oguz
O
Cebesoy
Volkan
V
Ergan
Gokhan
G
Maralcan
Levent
L
Altinel
Ahmet
A
Songur
Ilhami
I
Kuru
D000328:Adult; D002102:Cadaver; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004210:Dissection; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures / Q000379:methods*; D013628:Talus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*