Talar fractures are usually associated with hyperdorsiflexion of the ankle as the talar neck impacts the anterior margin of the tibia, such as in a motor vehicle accident or fall from height. Ankle injuries and talar neck fractures are almost always the result of a highenergy trauma. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Anatomy the talus articulates superiorly with the tibia and fibula in the ankle mortise and the calcaneus and navicular inferiorly. A combined talar body fracture and medial malleolus fracture is. Fractures of the talar neck talar neck fractures account for approximately 50% of all talar fractures. The fracture may sometimes be difficult to identify on radiographs and ct may be necessary to identify the fracture line. Due to the rarity of these injuries, most of the literature published on treatment, complications, and outcomes has been limited to case series, preventing the ability to draw definitive conclusions 110. It always remains a topic of debate whether talar neck. A hawkins type iii fracture is a displaced fracture extending through the talar neck with dislocation at both the. This type of fracture often occurs during a highenergy event, such as a car collision or a highvelocity fall. Talar fractures are an uncommon injury, accounting for 10mm talar tilt. Talar body fractures of the talus are uncommon accounting for 7. Talar neck fractures pose treatment challenges with both initial injury and potential sequelae.
Hawkins 19651970 lateral process neck fractures sneppen 1977 talar body fractures moa. Pdf current concepts in talar neck fracture management. Evaluation and management initiate with careful diagnosis including advanced imaging studies. Ankle fractures resident comprehensive fracture course 4192016 2 introduction ankle fractures are extremely common treated by a wide variety of surgeons complex injury not just interns case 4192016 3 introduction ankle fractures highenergy pilon fractures lowenergy pilon fractures atypical ankle fractures 4192016 4. Operative treatment should, therefore, be considered for all.
Fracture of the lateral process of the talus in snowboarders. Fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. Accurate alignment of talar neck reestablish hindfoot mechanics stable. A talus fracture usually results from serious trauma to the foot. The talar head is the least common part of the talus to fracture. Most of these injuries were secondary to flying accidents.
Surgery to treat an open talus fracture often involves much more than lining up the broken pieces of bone. In the present study, we report a surgical treatment of hawkins type iii talar neck fracture through the approach of medial malleolar osteotomy and miniplate for fixation and discuss the therapeutic effects after long. Principles of management and techniques of treatment. Any information contained in this pdf file is automatically generated from digital. Surgical management of hawkins type iii talar neck. Swelling and tenderness in the dorsal midfoot may be a sign of a navicular fracture, lisfranc injury, or other tarsalmetatarsal injury. Excessively swollen soft tissues have higher rates of wound complications, and surgery may. Because the talus is important for ankle movement, a fracture often results in significant loss of motion and function. Olts have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. They tend to be intraarticular injuries and may extend to the neck and body. The injury, the management, and the aftermath the talus is a vital bone in an intimate and critical relationship within the surrounding architecture of the foot. A talus fracture often occurs during a highenergy event like a car collision.
Images of the hawkins iii talar neck fracture in the 18yearold male shown in fig. Talar fractures orthopaedicsone articles orthopaedicsone. Pins or screws may be needed, as well as treatment of the damaged muscles and other tissue. These rarely require treatment of them selves but a talar head fracture may be associated with other midfoot injuries including fracture dis locations, which will. Threedimensional reformatted ct image of the talus a and lateral ankle radiograph b show the divisions between the talar head, neck, and body dashed lines. The talus is the bone that makes up the lower part of the ankle joint. Management of osteochondral lesions of the talar dome.
Talus fracture other than neck trauma orthobullets. The reported incidence of talar body ranges from % to 61% 16, 67. They are usually sustained when the foot is plantar flexed and there is a forced axial load. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Regardless of the talar fracture location, there was a high association of adjacent fracture or disruption of the talar articulations in all three main anatomic types of talar fracture. Talar body fractures are defined by an inferior fracture line located within or posterior to the lateral process. Open fx management adult knee trauma radiographic evaluation. The incidence of avascular necrosis is low due to good vascularity, unlike talar neck fractures. However, there have been several important paradigm shifts from traditional.
Talar neck fractures are a rare but potentially devastating injury, which require a comprehensive understanding of. Current concepts in talar neck fracture management ncbi nih. Reduction in the traction on the surrounding soft tissues, in turn reducing swelling. The diagnosis, management and complications associated. A talus fracture is a break in one of the bones that forms the ankle. Because the talus is so important for ankle movement, a fracture often results in substantial loss of motion and function. Hawkins type i fracture is a nondisplaced fracture, without subluxation or dislocation. Well explain the types, how theyre treated, and the recovery timeline. Lateral ankle fluoroscopic view of initial reduction of talar neck fracture with kwires through dual incisions. The various complications are avascular necrosis, malunion, infections, late osteoarthritis, and ankylosis of subtalar joint. Insufficiency and nondisplaced fractures of the talar head. Ankle fracture is one of the most common lower limb fractures for they account for 9% of all frac.
This type of fracture often occurs during a highenergy event, such as a car collision or a fall from a significant height. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. The accuracy of closed reduction of displaced talar neck fractures can be very difficult to assess. Significant softtissue disruption is frequently associated with highgrade talar neck fractures. Sangeorzan surgical treatment of talar body fractures this information is current as of april 23.
Specifically, there was fracture of an adjacent bone in the ipsilateral foot or ankle in 77%, 72%, and 88% of talar body, neck, and head fractures, respectively. Management of fracture neck of talus and clinical evaluation. In addition, a talus fracture that does not heal properly can lead. Management of talar neck fractures is based on the grade of displacement. A hawkins type ii fracture is a displaced vertical talar neck fracture with a subluxation or dislocation of the subtalar joint. Highenergy trauma that produces displaced talar neck fractures interrupts the blood supply of the talus and often causes varying degrees of articular cartilage. The entire length of the fibula should be palpated to rule out an associated proximal fracture maisonneuve injury. The talar tilt test examines the integrity of the lateral ankle ligaments, mainly the calcaneofibular ligament. An osteochondral fracture is the most common talar body fracture followed by fractures of the lateral and posterior processes. A talar fracture is a break in the continuity of one of the bones that forms the ankle. Talar body fractures include in order of frequency fractures of the talar dome, fractures of the lateral and posterior processes and true fractures of the talar body. In 1919, anderson reported 18 cases of fracture dislocation of the talus and coined the term.
Talar head fractures are rare, are difficult to diagnose, and have a reported incidence ranging from 3% to 10% of all talar fractures. Talar neck fractures have traditionally been quoted to account of less than 1% of all fractures. Up to 20% of cases present as open injuries with an anterolateral wound at. Reduction involves restoring the anatomical alignment of a fracture or dislocation of the deformed limb. Talus fracture other than neck 2212017 1059 views trauma. Sneppen analyzed fiftyone talus fractured patients for an average time of 23 months after treatment. Talus fractures can vary in location, severity and type including stress fracture, displaced fracture, undisplaced fracture, comminuted fracture etc. A talus fracture often occurs in association with a rolled ankle particularly.
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