FRACTURES OF THE TALUS

FRACTURES OF THE TALUS


FRACTURES OF THE TALUS

  • Talus also known as ‘Astragalus’.
  • Unique bone, has no muscle or tendon attachments.
  • Held in place mainly by bony and ligamentous support.

Blood Supply

  1. Posterior tibial artery—through calcaneal branches
  2. Anterior tibial artery—through anterolateral/ anteromedial malleolar branches or through medial tarsal artery
  3. Peroneal artery—through perforating branches
  4. Artery of the tarsal canal, a branch of posterior tibial artery
  5. Artery of the sinus tarsi, a branch of dorsalis pedis artery

MECHANISM

  • Fracture of the neck of the talus results from forced dorsiflexion of the ankle.

Classification of the Fractures/Dislocations and Fracture—Dislocations of the Talus

  • Following injuries are seen in the talus:
  1. Talar neck fracture
  2. Talar body fracture
  3. Talar head fracture (rare)
  4. Subtalar dislocation
  5. Total talar dislocation

Classification of talar neck fracture

  • Based on Hawkins’ classification (1970) it is classified as follows:
  1. Undisplaced vertical fracture.
  2. Displaced fracture with subtalar joint subluxation/ dislocation.
  3. Displaced fracture with both subtalar and ankle dislocation.
  4. Displaced fracture with subtalar, ankle and talonavicular dislocation.

Classification of talar body fractures
  • Based on Sneppen classification (1977) they are classified as follows:
  1. Osteochondral dome fractures
  2. Coronal, sagittal, horizontal shear fractures
  3. Posterior process fractures
  4. Lateral process fractures (Snowboarder’s fracture)
  5. Crush fractures
  • Talar head fractures are rare and generally associated with talonavicular dislocation/subluxation.

Complications

  1. Osteochondral fracture may cause loose body inside the joint which results in persistent pain and limitation of movement.
  2. Nonunion in fracture neck of the talus.
  3. Avascular necrosis of the body of the talus.
  4. Degenerative arthritis of the ankle.

Hawkins’ sign:

  • This is a sign seen at the end of 6-8 weeks which indicates presence of good vascularity.
  • This can be clearly visualized in a mortise view as a subchondral radiolucent band in the dome of the talus.

Treatment

1. Nonoperative:

  • Fractures which are undisplaced/ displaced less than 1 mm are immobilized in plaster cast.

2. Operative:

a) Internal fixation: 

  • Displaced fractures such as Types II, III and IV neck fractures;
  • coronal, sagittal and horizontal shear fractures of the body are openly reduced and internally fixed.

b) Arthroscopy:

  • Arthroscopic procedures are done for removal of loose body,
  • management of osteochondral lesions and in early degenerative arthritis of ankle.

c) Arthrodesis:

  • Indicated in secondary complication of nonunion, avascular necrosis and degenerative arthritis 

d) Total joint arthroplasty:

  • Indicated in secondary degene rative arthritis (without AVN).

e) Talectomy or Astragalectomy:

  • Rarely done as it renders the ankle highly unstable.
COMPLICATIONS
  1. Avascular necrosis and non-union
  2. Osteoarthritis

Exam Important

  • Ligament supporting the talus is Spring ligament.
  • Ligament supporting the head of talus is Plantar calcaneonavicular ligament.
  • Most common complication of talus fracture is Avascular necrosis.
  • Fracture of talus without displacement in x-ray would lead to Osteoarthritis of ankle & Avascular necrosis of body of talus.
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