Talar fractures

1. TALAR
FRACTURES
DR. TARUN KUMAR BADAM
PG DNB ORTHO
IORAS

2. OSSEOUS ANATOMY OF
TALUS
❖ Talus is one of the 7 tarsal bones of the foot
❖ It acts as a connecting link between the Foot and the Leg
❖ It is unique as 60% of it’s surface is articular, which articulates
with Tibial plafound, Medial malleolus, Lateral malleolus,
Calcaneum, and Navicular bones
❖ It has Ligamentous and Capsular attachments, but no
muscular attachments

3. In Greek Mythology, Talos was a giant God with single large vein coursing through his
body.Because of this vulnerable vascularity, his crucial weakness was ease of
exsanguination
❖ Talus has
A. Head
B. Neck
C. Body
D. Lateral Process
E. Posterior Process

4. ❖ Head is intra-articular
• Anteriorly : NAVICULAR bone
• Inferiorly : Sustentaculum Tali of
Calcaneum
❖ Head is supported inferiorly by
Plantar Calcaneo-navicular or
Spring ligament
❖ All three together form Talo-
Calcaneo-Navicular joint

5. ❖ NECK is non-articular
❖ It forms 15˚ angulation medially
with the body
❖ Medial - Sinus Tali corresponds
with Sinus Calcani to form
TARSAL CANAL
❖ Lateral - tarsal canal opens into
funnel shaped TARSAL SINUS

6. ❖ BODY :
• Superior surface
• Inferior surface

7. ❖ LATERAL PROCESS :
• Wedge shaped
• Superiorly and Laterally -
Lateral malleolus
• Inferiorly and Medially -
Calcaneum

8. ❖ POSTERIOR PROCESS :
• It has Medial and Lateral tubercle
• FHL in b/n
• Lateral : Anterior, Lateral, and
Posterior Talofibular Ligament
• Medial : Deltoid ligament
• OS TRIGONUM - seen in 50%
people, develops from separate
ossification centre posterior to
Lateral tubercle

9. VASCULAR ANATOMY OF
TALUS
❖ Talus 60% of it’s surface is articular
❖ It receives blood supply through Capsular and Ligamentous attachments, and Nutrient
foramen in the Neck
❖ Talus is supplied by
A. Anterior Tibial artery
- Dorsalis Pedis artery
B. Posterior Tibial artery
- Posterior tubercle artery
- Artery of Tarsal Canal
- Deltoid artery
C. Peroneal artery
- Artery of Tarsal Sinus

10. MEDIAL LATERAL

13. ❖ Head and Neck - by DPA
❖ Body
- Medial 1/3 - Deltoid lig
- Middle 1/3 - Artery of Tarsal
Canal
- Lateral 1/3 - Artery of Tarsal
Sinus
❖ Posterior tubercle
- Branches from Posterior
Tibial artery

14. ❖ Crucial Anastomotic Sling is formed in
the Tarsal canal b/n Artery of Tarsal
canal and Artery of Tarsal Sinus
❖ It gives branches to the Body of Talus
from Distal to Proximal
❖ In # Neck of Talus, this is disrupted
leading to Osteonecrosis of Body of
Talus

15. TALAR FRACTURES
❖ 2nd most common tarsal # after Calcaneal #

16. CLINICAL EXAMINATION
❖ Patients presents with h/o trauma
❖ Followed by c/o Pain and swelling of the hind foot
❖ Restriction of movements of the ankle
❖ O/E : Tenderness over Talus and Subtalar joint
: Restriction of Ankle and Subtalar movements

17. RADIOLOGICAL
EXAMINATION
❖X- RAYS
1. AP VIEW
2. LAT VIEW
3. CANALE VIEW
- For better visualisation of
neck of Talus

18. ❖ CT SCAN - required to detect the fracture pattern
❖ MRI SCAN - may be done to identify the soft tissue
injury

19. CLASSIFICATION
❖ TALAR HEAD FRACTURES
❖ TALAR NECK FRACTURES
❖ TALAR BODY FRACTURES
❖ LATERAL PROCESS FRACTURES
❖ POSTERIOR PROCESS FRACTURES

20. TALAR HEAD FRACTURES
❖ MECHANISM OF INJURY:
• Fall from ht, with Foot in plantar
flexion and compression force
along the long axis of the
forefoot
Talo-Calcaneo-Navicular jt
disruption
Shortening of the medial column
Loss of the Medial longitudinal
arch

21. TREATMENT

23. TALAR NECK FRACTURES
❖ Most common type of Talar
Fractures
❖ It is so called, if # inferior line is
distal to Lateral process of
Talus
❖ AVIATORS ASTRAGALUS :
Pilots resting the sole of the
foot on the rudder bar in crashing
plane at the point of impact
causes Hyperdorsiflexion of ankle
causing Talar neck #

24. MECHANISM OF INJURY
With Hyperdorsiflexion, Posterior capsular ligament of Subtalar jt
rupture and Neck of Talus impacts against Anterior edge of Tibia,
leading to TALAR NECK #
With continuation of dorsiflexion force, Calcaneus with rest of foot
subluxate forward, leading to Subtalar Subluxation
With continuation of dorsiflexion force, Posterior capsular ligaments of
ankle jt, Posterior Talo-fibular lig, and Deltoid lig rupture
Body of Talus is the wedged Postero-medially out of Tibial mortise, b/n
Medial malleolus and Tendo-achilles, leading to Subluxation of ankle jt
With further dorsiflexion, Talo-navicular jt subluxation occurs

25. HAWKIN’S CLASSIFICATION
❖ Type I : Nondisplaced
❖ Type II : Displaced with Subtalar
Subluxation
❖ Type III : Ass with Subtalar and Ankle
subluxation
❖ Type IV : Ass with Subtalar, Ankle and
Talo-Navicular subluxation
AVN
TYPE I 0-25%
TYPE II 25-50%
TYPE III 50-75%
TYPE IV 75-100%

27. TREATMENT

28. SURGICAL APPROACH
❖ Type II, III, IV are difficult to obtain anatomical reduction by closed reduction

31. TALAR BODY FRACTURES
❖ It is so called, if # line is proximal to Lateral process of
Talus
❖ Incidence of AVN is same in Neck and Body #, but Post-
traumatic arthritis is more with Body #

32. MECHANISM OF INJURY
❖ Axial compression of Talus b/n Tibial Plafound and
Calcaneum
❖ Occurs due to fall from height or Motor vehicular
accidents

33. CLASSIFICATION

34. TREATMENT

35. CALCANEOTIBIAL FUSION
BLAIR TIBIO-TALAR SLIDING GRAFT
ARTHRODESIS
Antero-lateral incision Antero-lateral incision
Talectomy done Comminuted # fragments are removed
Posterior Displacement of navicular to
come in contact with Tibia
Sliding graft from anterior surface Tibia
used to fill the gap
Painless and stable No Posterior displacement of navicular
Decrease in Height and length of foot Foot is not shortened
Ankle and Subtalar jt are lost Subtalar and Talo-navicular jt are intact
Compensatory Midtarsal movements are
present
Subtalar and Midtarsal movements are
present

39. LATERAL PROCESS OF
TALUS #
❖ Lateral process # occurs on EVERSION OF DORSIFLEXED AND
AXIALLY LOADED FOOT
❖ Seen in Snowboarding injuries
❖ Lateral process has attachments to Anterior, Lateral and Posterior
Talo-fibular ligaments
❖ V-sign for Radiographic diagnosis

41. HAWKINS CLASSIFICATION

42. TREATMENT

44. POSTERIOR PROCESS OF
TALUS #
❖ Posterior process of Talus has
Medial and Lateral tubercles with
FHL passing in the groove
❖ Medial tubercle - Deltoid Lig
❖ Lateral tubercle - Posterior
Talofibular lig

45. MECHANISM OF INJURY
❖ Medial tubercle of Posterior process # - Forceful
eversion of the ankle
❖ Lateral tubercle of Posterior process # - Forceful
inversion of the ankle

46. TREATMENT
❖ Undisplaced - Conservative
❖ Displaced - ORIF with Herbert screw fixation

47. Lorem Ipsum Dolor
COMPLICATIONS
OF NECK OF
TALUS #

48. 1. OSTEONECROSIS of Body of Talus :
in # neck of Talus, Due to loss of blood supply
- TALECTOMY + TIBIOCALCANEAL FUSION
- BLAIR TIBIO-TALAR SLIDING GRAFT ARTHRODESIS
2. Post-traumatic Arthritis
3. Malunion of Neck of Talus
- CORRECTIVE OSTEOTOMY OF NECK
4. Skin necrosis

49. HAWKIN’S SIGN

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