Talus Fracture Treatment and Complications
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Talus Fracture Treatment and Complications
- 9. Fracture of neck: ◦ by violent hyperextension of ankle, neck forced against anterior edge of tibia. Fracture of body: ◦ compression injury due to fall from a height. ◦ These are uncommon.
- 11. Fracture of neck of talus (Hawkins and Canale): Group 1: undisplaced Group 2: displaced, subtalar dislocation or subluxation Group 3: displaced with dislocation of body of talus from ankle joint Group 4: displaced vertical talar neck fracture with associated talonavicular joint disruption
- 13. Uncommon Often displaced May cause distortion of talocalcaneal joint. Deformity best visualized by three dimensional CT reconstruction.
- 14. Painful and swollen foot and ankle In displaced fracture • Obvious deformity • Skin may be tented or split which may be dangerous sign The pulses should be checked and compared
- 15. X-ray AP, lateral and oblique view essential CT help to identify associated ankle and foot injury Frequently missed (mostly undisplaced fracture) because of overlapping of tarsal bones.
- 17. Below the knee plaster and when swelling subsided replaced by complete cast with foot planterflexed.
- 18. Displaced fractures of neck • If skin tight: urgent reduction • For type II :Closed reduction under general anaesthesia • If it fails: open reduction • For type 3: urgent ORIF Displaced fracture of Body: • Minimal displacement below knee non-weight bearing cast for 6-8 weeks • Replaced by weight bearing cast for another 4 weeks • If adjacent joints dislocated: ORIF
- 19. Fig: Fractures of the talus – treatment
- 21. Displaced fracture of head: ◦ If large fragments: ORIF ◦ If much comminution – excise smaller fragments Displaced fracture of Talar process ◦ If fractures are large enough: ORIF, fixation with k- wires or small screw
- 22. Avascular necrosis and non –union • Evetually osteoarthritis of ankle Secondary osteoarthritis • avascular necrosis • injury to its articular cartilage, lead to osteoarthritis of ankle • Patient with osteoarthritis have complains of pain and stiffnes Treatment mostly by physiotherapy and in severe cases an ankle arthrodesis may needed
- 24. Maheshwari, Essential Orthopedics, 5th edition Apley’s System of Orthopedics and Fractures
- 25. NEXT Fracture of CALCANEUM
Editor's Notes
- Tarsal bones: 7 ( Talus, calcaneus, navicular, cuboid, cuneiform - 3) Only bone of the foot without any muscle attachment and a major weight bearing structure. connecting link between bones of foot and leg. It articulates with four bones
- Blood supply from the anastomotic ring of the blood vessels, the osseous vessels entering its neck and running postero laterally to supply its body. Blood supply often cut off following fractures occurring through the neck.
- Minor fractures in the form of a small chip from the margin of one of the articular surface of the talus are more common than the major one i.e. the fracture the neck of the talus.
- Results from forced dorsiflexion of the ankle. Typically this injury is sustained in an aircraft crash where the rudder bar forcibly against the middle of the sole of the foot (Aviator’s fracture), resulting in forced dorsiflexion of the ankle; the neck, being a weak area , gives way. This may be associated with dislocation of the body of the Talus backwards, out of ankle mortise.
- Based on dislocation of talus. It is useful to predict the long term outcome and development of avascular necrosis of talus.
- Worst is neck, like in scaphoid, there is retrograde blood supply. Thus, when neckis fractured, or even in slightest displacement, then there is avascular necorsis in the proximal region region. Therefore, relative emergency.
- Closed reduction: Traction applied with ankle planterflexion, foot then steered into inversion or eversion to correct displacement. Checked on x-ray. Below knee cast is applied and retained no weight bearing for 4 wks. Weight bearing not permitted till reunoion 8-12 wks