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Journal of Bone and Joint Surgery, 1945;27:587-594.
© 1945 by The Journal of Bone and Joint Surgery, Inc

ASEPTIC NECROSIS OF THE ASTRAGALUS FOLLOWING ARTHRODESING PROCEDURES OF THE TARSUS

FREDERICK M. MAREK M.D.1 and ALBERT J. SCHEIN M.D.1

1 Orthopaedic Service of the Mount Sinai Hospital, New York

1. Aseptic necrosis of the body of the astragalus is a not infrequent complication following arthrodesing procedures, requiring extensive resection of the head and neck of the astragalus, in order to correct severe deformities of the foot.

2. The frequency of this complication is sufficient to suggest that, when wide wedges are essential, the scaphoid should be sacrificed in preference to the astragalar neck.

3. Aseptic necrosis, if present, may be detected by roentgenographic examination as early as three to four weeks after operation. Suitable precautions should then be instituted.

4. Revascularization in the average adolescent takes place quite rapidly (six to nine months). Collapse of the body of the astragalus may be prevented by not permitting weight-bearing until this has been accomplished.

5. If premature weight-bearing is allowed, the body of the astragalus will become commmpressed, and the ankle-joint surface damaged, resulting in secondary osteo-arthritis of the ankle joint. This may require subsequent fusion for relief of pain and disability.

6. If ankle fusion is part of the primary procedure, aseptic necrosis of the astragalus is not as serious a complication.


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C. K. JONES and J. A. NUNLEY
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