The talus is one of the three bones involved in the ankle joint. There is an increased incidence of talus fracture among snowboarders due to the unique stress placed on the talus when landing from jumps on a snowboard. A talus fracture is a break in the small bone at the base of the ankle. This type of fracture often occurs during a highenergy event, such as a car collision or a highvelocity fall. Talus fractures pediatric orthopaedic society of north.
The treatment of talar body fractures with compression. Because the talus is important for ankle movement, a fracture often results in significant loss of motion and function. Talus fractures a talus fracture is a break in one of the bones that forms the ankle. Fractures of the main portion of the talar body and of the talar head are uncommon. They are a heterogeneous entity of injuries in terms of mechanism, pathology, treatment and outcome. In this case the fracture may he either non displaced or displaced.
Roughly about 50% of the fractures of the talus involve the talar neck. Talus fracture the talus taylus is a small bone that sits between the heel bone calcaneus and the two bones of the lower leg tibia and fibula. Talar fractures are an uncommon injury, accounting for ii fractures of the talus r. A talus fracture is a break in one of the bones that forms the ankle. Through a minimally invasive technique, the talus fracture was reduced and. No classification scheme exists to describe this fracture, though the two patterns described for the head are crush injury to the articular surface with significant comminution and shear fractures. Apr 10, 2020 fractures of the talus include a broad spectrum of injuries and consequently require an individualized approach to their evaluation and management. Talus fractures most commonly occur as a result of a fall or other type of trauma. We treated three patients with talus body fracture and multiple articular. Partial syno vectomy, washing out, reduction of the fracture site, and osteosynthesis using 2 navicular cannulated screws placed. A high index of suspicion is necessary to diagnose a fracture of the os trigonum after a severe plantarflexion injury to the ankle. For that reason fewer than 80 cases only five cases in japan have been reported and the mechanism of injury and treatment policy have yet to be established. Its the essential piece needed to enable the up and down movement of the foot.
Fractures of talar body are uncommon injuries often associated with fractures of. Pdf talus fractures continue to represent a challenging and commonly encountered group of injuries. The talus is predisposed to avascular necrosis avn, or bone death due to ischemia, owing to. It connects the heel with the lower leg bones to form the ankle. A talus fracture usually results from serious trauma to the foot. We report a case of a fracture of the os trigonum, its clinical features, treatment and significance. The talus connects the top of the foot to the ankle and provides much of the joints stability, range of motion, and weightbearing ability. Talar neck fractures have been described in association with compression injuries of the calcaneocuboid joint.
This type of fracture often occurs during a highenergy event, such as a car collision or a fall from a significant height. Treatment for the minimally displaced or stable fracture can sometimes be treated with immobilization such as a cast. Godoysantos, 20 talus fracture may also be associated with fractures of the distal tibia. A talar fracture is a break in the talus bone of your foot. Fractures of the lateral and the posterior processes of the talus are uncommon but important injuries that may result in significant disability in. Children must be provided a safe environment to work, study, or play. Fractures of the talus include a broad spectrum of injuries and consequently require an individualized approach to their evaluation and management. A badly twisted ankle can also cause small pieces of the talus to break off. Oct 26, 2017 a talus fracture usually results from serious trauma to the foot. Most talus fractures, particularly displaced fractures require operative treatment in the form of surgical reduction with screws.
After the fracture has healed, patient should be enrolled in a rehab program with emphasis on stretching and strengthening so as to get the mobility and flexibility back and for range of motion of foot. Oct 05, 2018 surgery may be done to excise the lateral process of talus bone. This scenario, however, is the exception and not the rule. Fractures of the talar dome, lateral process, and posterior process occur primarily in young athletes. Lateral rotation of the tibia on the talus the impacting force was further increased by external rotation of the tibia on the talus. When the cartilage is injured, the normally smooth joint surface becomes uneven. Fractures occur when the narrow neck of the talus, with its less dense trabecular bone, strikes the stronger anterior tibial crest. It is the second most common type of tarsal fracture with an incidence of 0. The diagnosis, management and complications associated. Mar 02, 2020 a talus fracture is a break in the small bone at the base of the ankle. Talar fracture in adults discharge care what you need. Avascular necrosis of the talus rsna publications online. Surgical treatment of talus fractures a retrospective study of 80 cases followed for 115 years wito schulze, jens richter, otto russe, patrick ingel nger and gert muhr department of surgery, bgkliniken bergmannsheil, ruhruniversity bochum, germany.
Peripheral talar fractures comprise fractures of the lateral and posterior process with its lateral and medial tubercle, the medial or mediocaudal ridge, the talar head as well as traumatic osteochondral lesions of the lateral and medial talar dome. One of the most challenging diagnoses for general orthopedic surgeons as well as fracture specialists is a fracture of the talar neck. Well explain the types, how theyre treated, and the recovery timeline. Smith introduction fractures of the talus comprise only a very small pro portion of foot injuries but its unique anatomy and pathology increase its importance with regard to sur gical interest and potential disability for the patient far in excess of. Injuries that could cause a talus fracture include a fall from a great height or a car accident.
Care should be taken to ensure that the deltoid attachment to the medial malleolus is preserved. They are usually sustained when the foot is plantar flexed and there is a forced axial load. Blood supply wildenauer was the first to correctly describe in detail the blood supply to the talus. We encountered cases of isolated fracture of the lateral process of. Fore 2014 current solutions in foot and ankle surgery. They tend to be intraarticular injuries and may extend to the neck and body. It has an odd humped shape, somewhat like a turtle. The simple fracture without displace ment of the neck of the talus seldom presents any problems as regards treat. We will explain what causes a talus fracture, the different types of talus fracture, how a talus fracture is diagnosed, different ways to treat a talus frac. Talus fracture types everything you need to know dr. The most important phrase in the original greek is the talus dislocated out of the joint. Jan 11, 2020 arthritis is common after a talus fracture because so much of the bone is covered with cartilage. Fracture characterization is essential to guide the manage. Peripheral talus fracturesa clinical observational study.
In these cases, this medial fracture plane can be used similar to a medial malleolar osteotomy to address the talus injury. Fractures are often very painful and cause major swelling and tenderness. We report a case of talar neck fracture that occurred in a 4yearold girl. Transchondral fractures of the talus on an inversion. One of the first reports of an injury of the talus is by herodot 490420 b. The talus is a small bone at the ankle joint that connects the heel bone and the shin bones.
Talus iind most common tarsal fracture 60% coverage by articular cartilage no tendon muscle attachments tenuous blood supply 90% of motion of foot ankle body, neck, head, lat. Peripheral talus fracturesa clinical observational study of. The talus, the second largest tarsal bone, has distinctive. Arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint. Accurately detecting, classifying, and managing talar injuries can be a challenging endeavor due to the unique anatomic characteristics of the talus and subtle radiographic findings of the injuries. His findings were confirmed by haliburton et al2 through gross dissection and micro. Talar head fractures occur at the articular surface of the talonavicular joint and may have associated subluxation or dislocation of the talus and fractures of adjacent bones. A type i fracture is through the neck of the talus without dislocation or subluxation, where only one source of blood supply may be jeopardized fig 2. Drawings illustrate the hawkins classification system for talar neck fractures. To prevent a talus fracture, individuals should be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. It connects the calcaneus with the tibia and fibula lower leg bones to form the ankle. Management of fracture neck of talus and clinical evaluation.
There can be fractures of the talar neck, the lateral process of the talus and the talar head. The infrequency of displaced talar fractures means that orthopaedic residents receive relatively little training in this area. The accuracy of closed reduction of displaced talar neck fractures can be very difficult to assess. Talar neck fractures are classified by hawkins method 1970, together with that of canale and kelly 1978 to include a type iv fracture table 1. The high variability of talar fractures, their relatively low incidence together with the high percentage of concomitant injuries makes treatment of these injuries a challenge to the surgeon. Talus fractures philipp leucht, md stanford university school of medicine orthopaedic trauma course for nppas ota 20 outline anatomy surgical approaches fixation strategies outcomes and complications anatomy bone 6070% articular cartilage no muscular attachments complex articulations anatomy vascular 1.
The talus bone is a square, flat bone on top of the calcaneus heel bone. Fracture of lateral process of talus hawkins classification 87. Anatomical reconstruction of malunited talus fractures taylor. Talus fractures are known to be difficult and challenging pathological conditions. Talar fractures are an uncommon injury, accounting for nov 25, 2016 fractures of the talus ortho tube. The bones of the lower leg ride on top and around the sides to form the ankle joint. Current orthopaedics 1997 11, 2427 1997 pearson professional ltd trauma masterclass. Fractures of talar body are rare and serious injuries and frequently seen in multiply injured and polytraumatised patients. Fixation of osteochondral lesions of the talus using cortical bone pegs.
Epidemiological study on talus fractures pubmed central pmc. Familiarity with these imaging findings is essential for timely diagnosis and classification of talar injuries. The talus ranks as the second largest tarsal bone with unique anatomic features and serves an important role in mobility of the foot and ankle. If the fracture doesnt heal properly, you could have walking problems. Even in the setting of an obvious talus fracture, radiographs must be scrutinized to rule out additional injuries. Pdf fracture of the talus is uncommon in childhood. A pivotal jbjs article in 1978 focused attention on these vexatious injuries. As a result, talus fractures are often accompanied by other injuries, including dislocation of adjacent joints and fracture of neighboring bones. The talar head is the least common part of the talus to fracture.
Surgery may be done to excise the lateral process of talus bone. After reduction and fixation of the talus injury, reduction and fixation of the medial malleolus or plafond injury is undertaken. A 41yearold male was involved in a high speed accident and was taken to the orthopedic trauma service of hospital for special surgery for treatment by david l. Jul 04, 2018 in these cases, this medial fracture plane can be used similar to a medial malleolar osteotomy to address the talus injury. Those who participate in snowboarding, skiing and other winter sports have a higher incidence of talus fractures. A talus fracture occurs in about 57 of foot injuries. We discuss talus fracture aka broken foot with simple language and useful pictures to help everyone understand this topic. Fracture of the lateral process of the talus is a common, yet frequently missed, injury. Ankle injuries and talar neck fractures are almost always the result of a highenergy trauma. It always remains a topic of debate whether talar neck.
Pdf fractures of the lateral and the posterior processes of the talus are uncommon and frequently missed because of a low level of suspicion. Jan 01, 2000 fracture of the lateral process of the talus is a common, yet frequently missed, injury. There are several factors contributing towards this reputation. Transchondral fractures of the talus on an inversion injury. Ankle fracture is one of the most common lower limb fractures for they account for 9% of all frac. Talus fractures outline orthopaedic trauma association. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Feb 03, 2020 a talar fracture is a break in the talus bone of your foot.
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