What Is a Talus Fracture?

A talar fracture is a talar fracture mainly manifested by local swelling, pain, subcutaneous bruising, and inability to stand and walk. Talus fractures are rare and are mostly caused by direct violent crushing or indirect compression from a fall, which is often associated with calcaneal fractures. The prognosis of talar fracture is not very ideal, and it is easy to cause non-union or ischemic necrosis.

Basic Information

English name

fracture of talus

Visiting department

orthopedics

Common locations

Talus

Common causes

Mostly fall from heights, the direct impact of violence

Common symptoms

Local swelling, pain, subcutaneous ecchymosis, inability to walk, etc.

Causes of talar fractures

Talus body fractures are mostly caused by falling from a height and directly impacted by violence. The talar body can fracture in the horizontal plane, and can also form a longitudinal split fracture. Fractures can be linear, stellate, or comminuted. Talus body fractures often affect the ankle and subtalar joints. Although the displacement is very light, it can lead to stepped deformities of the joints and eventually lead to traumatic arthritis. Therefore, the prognosis of talar body fractures is worse than that of talar neck fractures.

1. Talus neck and body fractures

Mostly fall from the ground, with the heel on the ground, the violence is down the tibia, the reaction force is from the heel up, the front of the foot is strongly dorsiflexed, the lower edge of the tibia is inserted between the talar neck and body, causing the talar body or talar neck Fracture, the latter is more. Such as strong foot valgus or eversion, can cause talar fracture and dislocation. After the talar neck fracture, the talar body can cause ischemic necrosis due to circulation disorders.

2. Talus posterior process fracture

The strong plantar flexion of the foot is caused by the impact of the posterior edge of the tibia or the upper edge of the calcaneal tuberosity.

3. Talus blood supply

(1) The posterior tibial artery is divided into three branches of the posterior tibial artery. The metatarsal canal artery supplies the middle and outer 1/3 of the talar body, which coincides with the branch of the anterior tibial artery and the tarsal sinus artery. A triangular branch occurs about 5 mm from the tarsal canal artery, supplying 1/3 of the medial body of the talus.

(2) The anterior tibial artery can be divided into three branches and two branches inward, which coincide with the triangular branches below the medial malleolus. Outward occurrence of the tarsal sinus artery supplies the lower half of the talar head and part of the talar body. The dorsal arteries of the dorsal foot arteries directly supply the talar neck and upper medial head.

(3) Two branches of the peroneal artery coincide with the calcaneal branch of the posterior tibial artery; the other branch coincides with the iliac sinus artery.

The talus fracture image is comprehensive. It can be seen that the upper and inner half of the talar head is supplied by the dorsal artery of the dorsal foot artery, the sacral sinus artery is supplied by the lower outer half, and the middle and outer 1/3 of the talar body are supplied by the tarsal canal artery. The inner 1/3 is supplied by the triangular branch. The sacral sinus artery also supplies the next small part, and the posterior talar nodule is supplied by the calcaneal branch of the posterior tibial artery.

Although the blood supply of the talus is abundant, most of the talar surface is covered by articular cartilage, without muscle attachment; the blood vessels enter the talus where they are concentrated and easily damaged; the talus is cancellous, and the bone will be compressed during trauma and hurt the blood vessels Therefore, fracture or dislocation is prone to ischemic necrosis.

Clinical manifestations of talar fractures

After the injury, the lower part of the ankle is swollen, painful, unable to stand and walk with weights. Dysfunctions are very significant and are easily confused with simple ankle sprains. The talar neck fracture was second-degree, with tenderness in the anterior lower part of the ankle joint and the longitudinal axis of the foot. The talar body prolapsed from the ankle point, the swelling inside and behind the ankle was severe, there were obvious protrusions, flexion contractures of the toes, foot eversion and abduction. Bony protrusions can be touched at the back of the medial malleolus, and pale skin ischemia or cyanosis can occur.

In the case of talar posterior process fractures, in addition to tenderness at the back of the ankle, the foot is plantar flexion, and the ankle dorsiflexion can make the pain worse; in the case of a longitudinal split fracture, the ankle is swollen severely or there are large congestion , Showing a varus deformity; a displaced bone mass can be touched on the inside or outside of the ankle joint.

Talus fracture examination

1. X-ray inspection

In addition to positive and lateral X-rays, special postures should be taken according to the injury.

2. Tomography or CT examination

For complex pelvic fractures or suspected intravertebral fractures, tomography or CT should be performed as appropriate.

Talus fracture diagnosis

Because calcaneal and ankle fractures can occur at the same time as talar fractures, sometimes clinical identification is difficult, and more X-ray examination is needed to confirm the diagnosis.

Differential diagnosis of talar fracture

This disease is easily confused with a secondary bone of similar size to the posterior talus, which is a smooth-bone subbone, and at the same time there is no defect in the posterior margin of the talus. The opposite is true for fractures of the posterior process of the talus, which should be identified.

Talus fracture treatment

In addition to the neck, the talus has more ligament attachment, and the blood circulation is slightly better. The upper, lower, and front directions are joint surfaces that are adjacent to the adjacent bone, and there is insufficient blood supply. Therefore, attention should be paid to accurate reduction and strict fixation. Otherwise, the incidence of aseptic necrosis and disconnection of bone is high. Depending on the type of fracture and the specific circumstances, appropriate treatment measures are taken.

Fracture without displacement

Should be fixed with plaster boots for 6 to 8 weeks. Try not to force support weight until the fracture is not solidified.

2. There is a displaced fracture

The talar head fracture is mostly displaced to the back side, which can be reduced manually. Pay attention to the fixed posture in the plantar flexion position so that the distal end is close to the proximal end. The plaster boots are fixed for 6 to 8 weeks. After the fracture is basically connected, it is gradually corrected to the 90 ° functional position of the ankle joint, and then fixed for 4 to 6 weeks, more solid healing may be achieved. Try not to force premature weighting. If the fracture of the talus body is severely separated, manual reduction can be successful, but strict fixation is required for 10-12 weeks.

If manual reduction fails, calcaneal traction can be used for 3 to 4 weeks, and then manual reduction. Then use plaster boots for strict fixation for 10-12 weeks. However, when the talar body is comminuted or split fracture, the cartilage surface of the upper and lower joints are mostly injured, and the rate of traumatic arthritis after healing is high, and recovery is often not very satisfactory.

If the fracture of the talar posterior process is displaced, the small fracture piece can be removed. When the fracture piece has a large impact on the articular surface, it can be fixed with a Kirschner wire and a plaster boot for 8 weeks.

3. Closed reset failure often requires surgical incision and restoration and internal fixation with screws

Talus neck fractures account for about 30% of talar fractures. When falling from a high place, the foot and ankle dorsiflex at the same time, the talar neck hit the front edge of the distal tibia, and a vertical fracture occurred. Can be divided into three types:

(1) Type I talar neck vertical fracture with little or no displacement.

(2) Type II talar neck fracture with subtalar joint dislocation. After the talar neck fracture, the foot continues to dorsiflexion, the talar body is fixed in the ankle point, and the rest of the foot is excessively dorsiflexed, causing the subtalar joint to dislocate.

(3) Type III talar neck fracture with talar body dislocation. After the talar neck fracture, the external force of dorsiflexion continues to work, the talar body rotates inward and backward to dislocate, and is interlocked behind the talar process, often with the medial malleolus fracture. Often open lesions.