Bipartite talus: A case series and algorithm for treatment

BackgroundBipartite talus is a rare condition of uncertain aetiology, with various treatment options described.MethodsWe report five symptomatic bipartite talus cases in four male patients warranting surgical management. All patients were reviewed by an independent assessor.ResultsThe youngest patient presented with bilateral lesions without sub-talar arthrosis. He was treated twice by internal fixation with bone grafting. The left side failed to unite. The second patient presented with isolated sub-talar osteoarthritis. He underwent fragment excision and sub-talar arthrodesis with bone graft. The third patient presented aged 55 with severe hind-foot osteoarthritis, and underwent tibio-talar-calcaneal fusion. The final patient was treated with fragment excision and sub-talar arthrodesis. All patients reported symptom improvement or resolution post-operatively. Four cases showed evidence of radiographic union.ConclusionsWe suggest a treatment rationale of fragment fusion if large enough, or excision if not, with associated limited fusion if the adjacent joints are markedly degenerate.