The microvascular anatomy of the talus: a plastination study on the influence of total ankle replacement.

PURPOSE: The purpose of our study was to systematize the arterial supply of the talus and characterize the vessel damage occurring in the talus after total ankle replacement. Previous studies exist using vascular injection to visualize the topic [Giebel et al. (Surg Radiol Anat 19:231-235, 1997); Mulfinger and Trueta (J Bone Joint Surg Br 52:160-167, 1970); Peterson et al. (Acta Orthop Scand 46:1026-1034, 1975); Peterson and Goldie (Acta Orthop Scand 45:260-270, 1974)]. The vascularization of the talus has previously been described by various authors [Aquino et al. (J Foot Surg 25:188-193, 1986); Haliburton et al. (J Bone Joint Surg Am 40:1115-1120, 1958); Mulfinger and Trueta (1970); Peterson et al. (1975); Wildenauer (Z Orthop Ihre Grenzgeb 113:730, 1975)]. The plastination method provides excellent intraosseous view of the arterial system and offers a helpful method to demonstrate the influence of the Scandinavian Total Ankle Replacement (STAR) on the blood vessels. METHODS: In a first step, the nutritive foramina were analyzed on 20 macerated cadaver feet. After this, the articular surface was measured with a print using Optosil. The next step was the visualization of the vascularization of the talus using the plastination method. After vascular injection, a STAR was implanted in two specimens and a plastination was done. RESULTS: The highest amount and density of nutritive foramina were found in the sulcus tali. Using the imprint technique for the examined tali, we found a mean area covered by cartilage of 56.9% in comparison to the total surface. The deep fin of STAR has the potential to eliminate important blood vessels of the talus. CONCLUSION: The plastination methods were useful methods to analyze the arterial supply of the talus. In our study, the STAR showed a dominant influence on the vascularization of the talus. The fin appeared to be too long. A design modification with a short fin could provide the arterial supply, but should be tested biomechanically.