Body

  • Broken Hand
  • NSAIDS: To Use or Not to Use
  • Hydrocele, Spermatocele and Strained Groin
  • Hand: Arthritis
  • Open-Heart Surgery
  • Osteopenia and Increasing Bone Density
  • Body: Pain Meds vs Sex
  • Appendectomy and Climbing Training
  • Body: Injury Truths
  • Body: BPA and Waterbottles
  • Body: Bouldering for Bone Density
  • Body: Chronic Injury
  • Body: Bouldering for the Bones
  • Body: Antibiotics and Tendon Damage
  • Back

  • Lumbar Bone Spurs
  • Options for Disc Herniation
  • Back: Spinal Fracture
  • Back: Preventing Hunchback
  • Back: Herniated Disc
  • Abdomen

  • Abdomen: Muscle Tear/Hernia
  • Arm

    No items found.

    Shoulder

  • Thoracic Musculature Tightness
  • Chronic Posterior Shoulder Pain
  • Supraspinatus and Labral Tears
  • Chronic Shoulder Pain
  • Shoulder Replacement
  • Shoulder Pain
  • Exploding Shoulder
  • Shoulder: Thoracic Outlet Syndrome
  • Shoulder: SLAP Lesion and Cortisone
  • Shoulder: Frozen Shoulder
  • Shoulder: Torn Labrum, SLAP Lesion
  • Shoulder: Separation
  • Shoulder: Pain and Virus
  • Biceps

  • Bursting Biceps
  • Elbow

  • Golfer's Elbow
  • Elbow: Brachioradialis Pain
  • Tennis Elbow
  • Medial Epicondylosis Tendonitis
  • Dodgy Elbows Revisited
  • Synovial Chips
  • Quack Elbow Treatments to Avoid
  • Elbow Pain and Cortisone Use
  • Do Compression Sleeves Work?
  • Elbow: Tennis Elbow
  • Elbow: Medial Tendonosis
  • Elbow Pain and Dodgy Elbows
  • Elbow: Tendonosis
  • Elbow: Medial Epicondylosis and Taping
  • Elbow: Tingling and Numbness
  • Elbows: Minimizing Fingerboard Injuries
  • Elbow: Medial Epicondyle Tendonosis
  • Elbow: Stress Fracture
  • Elbow: Pain and Hangboarding
  • Wrist

  • TFCC Tear
  • Wrist Pain From Cleaning Routes
  • Wrist: Klienbock's Disease
  • Wrist: Ruptured Tendon
  • Snap, Crackle, Wrist
  • Wrist: Fractured Scaphoid
  • Wrist: Instability
  • Hand

  • Broken Hand
  • Hand: Hook of the Hamate Fracture
  • Fingers: Everything You Need to Know About Finger Stress
  • Hands: Dupuytren's Disease (lump in palm)
  • Hands: Numbness and Carpal Tunnel Syndrome
  • Fingers

  • Swollen Right Index Finger
  • Pinky Numbness
  • Avulsion Fracture
  • Hand: Arthritis
  • Finger Numbness
  • Fourth Metacarpal Break
  • First Pulley Strain
  • Freezing Fingers Today, Benefit Tomorrow?
  • Cysts in Fingers
  • Ruptured Finger Pulley
  • Major Finger Pain
  • Fingers: What To Do with a Ruptured Flexor Digitorum Superficialis
  • Fingers: Everything You Need to Know About Finger Stress
  • Fingers: Hyper-extended
  • Fingers: Cysts and Pain
  • Fingers: Cracked Fingertips
  • Fingers: De Quervain's Tenosynovitis
  • Fingers: NSAID Treatment
  • Fingers: Torn A2 Pulley
  • Fingers: Trigger Thumb Syndrome
  • Fingers: Stiffness, Soreness
  • Fingers: Grip Position and Injury
  • Fingers: Cortisone for Tendon Injuries
  • Fingers: Pinky Finger Pain
  • Fingers: Electrostimulation
  • Hands: Numbness and Carpal Tunnel Syndrome
  • Fingers: Taping Truths
  • Fingers: Flappers
  • Fingers: Trigger-Finger Syndrome
  • Fingers: Torn A3 and A4 Pulleys
  • Fingers: Cysts
  • Fingers: Arthritis
  • Fingers: Numbness
  • Fingers: Blown Tendons
  • Leg

  • Leg: Achilles Tendonitis
  • Leg and Knee: Broken Femur and Shattered Kneecap
  • Leg: Pulled Hamstring
  • Leg: Fracture
  • Knee

  • Outside Knee Pain: Tibiofibular Joint
  • MCL Injury
  • Blown Knees
  • Knee Tendonitis after Ankle Fusion
  • Meniscal Tear on a Drop Knee
  • Knee: Rockfall Causes Lump
  • Knee: Chondral Injury of the Lateral Tibial Plateau
  • Leg and Knee: Broken Femur and Shattered Kneecap
  • Knee: Ruptured ACL
  • Knee: Ruptured Ligament and Meniscus
  • Knee: Synovial Cartilage Damage
  • Ankle

  • Osteochondral Talus Fracture
  • Knee Tendonitis after Ankle Fusion
  • Snapped ankle tendon
  • Possible Death of the Talus Bone
  • Broken Talus Bone
  • Ankle: Loud Pop Ankle Roll
  • Feet

  • Bunions
  • Dr. J Attacks Fungal Toenails
  • Feet: Broken Foot
  • Feet: Gout and Pseudogout
  • Feet: Toe Fracture
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    Possible Death of the Talus Bone

    18-May-2015
    By


      Talus fractures are common after short, hard falls. Sometimes the bone dies and surgical intervention is required. Illustration by Steve Graepel.I fractured my talus and have looked into the worst-case scenario—the death of the talus bone. My surgeon said if this happened, the best option would be an ankle fusion. I respect his surgical skills, but the more I talk to people, the more I conclude that he’s dead wrong. I haven’t heard anything good about ankle fusions and I’ve talked to two people who are happy with their ankle replacements. My PT said she would almost never recommend a fusion now that replacements are an option. Although a replacement is a new procedure, if you seek out the right specialist it sounds like you can have a good outcome. What do you think?

    —TLBZLAND, Rock and Ice Forum


    Dead wrong is, well, totally wrong. The two operations are not necessarily competitors for the best outcome.

    Really, who would you listen to when it comes to the management of a tricky orthopedic situation? I understand you may have researched this, but your specialist has spent years upon years learning and understanding the intricacies of surgical options. Google searches, trawling forums, or asking your friends does not trump your specialist. If only it were that easy.

    For starters, ankle replacement is usually contraindicated in patients with talus necrosis! Generally speaking, ankle replacement is for people over 50 with a debilitating form of joint disease such as rheumatoid arthritis, but with otherwise strong and healthy bones. You may also not realize that roughly a quarter of these replacements are failing within 10 years and over half have significant

    complications, considerably higher than for ankle fusion.

    By the time a joint becomes a candidate for fusion (arthrodesis), the range of motion is gone or extremely reduced anyway. This operation is not a fix, but an attempt at pain reduction and improved function, and may end up being an intermediate step to ankle replacement if you are too young or don’t immediately fit the profile for a replacement.

    Although most people will assume that an ankle replacement will allow greater range of motion (ROM) compared with an ankle fusion, there is only a marginal difference between the two and enhanced ROM is not considered an expected upside.

    Joint replacement surgery is rarely undertaken in a young patient (i.e. under 50). The prosthetic unit has a lifespan and will eventually fail—either within the hardware or at the point where the prosthetic joins to your tissue.

    I am not an expert on ankle replacements, but I would bet that aggressive replacements are more prone to failure and subsequent replacements become increasingly unsustainable. Each time a prosthetic is replaced, a certain amount of tissue is resected. Maybe you can do it once, maybe even twice—but maybe not at all.

    My point is that arthrodesis is not second fiddle to ankle replacement. In certain situations it may be an alternative, but in others joint fusion remains the best practice. Many factors dictate a surgical course of action.

    Don’t get me wrong, spend all the time you feel necessary to research your options. Knowing what possibilities are available will keep your medicos on their toes and help you understand what to expect.


    This article was published in Rock and Ice No. 216 (February 2104).

     

     



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