Bipartite talus: a case series and algorithm for treatment.

Background: Bipartite talus is a rare condition of uncertain aetiology, with various treatment options described.

Methods: We report five symptomatic bipartite talus cases in four male patients warranting surgical management. All patients were reviewed by an independent assessor.

Results: The 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.

Conclusions: We 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.