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Direct Bone Marrow Injections for Avascular Necrosis of the Talus: A Case Report
Authors: Ross A. Hauser, MD & Shelby Ostergaard
Avascular necrosis (AVN) of the talus is a debilitating condition, often leading to arthritis and arthrosis of the subtalar and ankle joints.1 There are three basic categories of cause for AVN. Approximately 10% of AVN of the talus is considered idiopathic: 15% is medication induced and 75% from trauma.2, 3 The most feared complication of talar injuries is AVN.
The talus has several anatomic features that predispose it to AVN. The body of the talus is wider anteriorly than posteriorly and contains the talar dome, which forms the talocrural joint with the tibia. This joint bears more weight per unit of area than any other joint in the body, contributing to its propensity to get injured with ankle trauma.4The talus is weakest at the neck, where the bone is recessed to allow for dorsiflexion. In addition, the talar neck has a scarcity of cartilage and numerous ligamentous attachments. Talar neck fractures represent 50% of all talar injuries and are responsible for 90% of all traumatic AVN.5
While arthroscopy with or without core decompression is the standard of care for unresolved cases of AVN of the talus, we present a case of AVN of the talar dome where symptoms resolved satisfactorily with direct bone marrow injections into structures into and around the ankle.