Revisiting the concept of talar shift in ankle fractures

Background. In 1976, Ramsey and Hamilton published a classic experiment investigating the biomechanical effects of talar shift in a simple ankle fracture model. Their finding was that 1 mm of talar shift resulted in a 42% decrease in tibiotalar contact surface area. Based on this conclusion, 1 mm of talar shift became the recognized indication for operative fixation. Methods: Twelve cadaver ankles were dissected and the distal tibia coated with carbon powder. A 70-kg load was applied to the distal tibia that resulted in transference of the carbon onto the talus. The contact surface area was determined at 0, 1, 2, 4 and 6 mm of talar shift using spacers fixed in the medial gutter. Tracing paper was used to mark the outline of the contact area and measured using graph paper. Results: Our results were similar to Ramsey and Hamilton's original experiment. One millimeter of lateral talar shift resulted in 40% loss of contact surface area compared with 42% in the original experiment. A large variance was seen in talar contact surface area depending on the morphology of the ankle joint. Conclusion: Ramsey and Hamilton's original experiment was valid.