Talus Fracture: Diagnosis and Treatment
Talus fracture can involve different parts of the bone which may be
Of the talus bone.
Here we will only look into talus neck fractures as they account for 90% of all talus fracture.
Please see the page on anatomy of the foot to get a getter understanding of this fracture. (skip if you have already done so)
Mechanism of injury causing fracture of the talar neck is a sudden force that pushes the foot upwards. This can occur during
- flying accidents hence it is also called aviators fracture
- road traffic accidents
- falling from height
Classification of talar neck fractures according to Hawkins
- Type 1 - undisplaced vertical fracture of the neck
- Type 2 - displaced fracture with partial or total dislocation of the body of talus from the talo-calcaneal (subtalar joint)
- Type 3 - displaced fracture with dislocation of the body of talus from the talo-calcaneal (subtalar joint) and ankle joint
- Type 4 - displaced fracture with dislocation of the head of talus from the talo-calcaneal (subtalar joint) and talo-navicular joint
Type 1 to 4 represents an increasing degree of severity of talus fracture.
- pain and
- swelling in the foot
- deformity of the foot and ankle
- skin of the foot may be ruptured
X rays will confirm the diagnosis and help in classification. Special x rays may be required to see the talus neck.
Treatment is according to the classification of the fracture.
- Type 1 fractures require plaster cast immobilization for 8 to 12 weeks. Cast is applied below the knee joint.
- Type 2 fractures urgent re-alignment of the fracture either by manipulation or by surgery. After re-alignment a plaster cast is applied for 8 to 12 weeks and the union of the fracture and complications are assessed at intervals.
- Type 3 fractures require emergency surgery. During surgery the fracture is realigned and stabilized by putting screws across the fracture site.
- Type 4 fractures may require treatment as above according to the position of the body of talus and further re-alignment of the head of talus. During surgery screws are used to stabilize the fracture.
- sloughing of skin and infection
- avascular necrosis or death of the body of talus
- delayed union of the fracture
- malunion or union in the wrong position
Frequently Asked Questions
How long does the fracture take to unite?
Union usually takes 3 to 4 months. There can be a delay in union and the fracture can take upto 18 months for union.Delay in union is thought to occur because the talus has a poor and fragile blood supply.
How does mal-union occur and how can it be prevented?
Mal-union occurs when the patient comes late for treatment of a talus fracture or when the treating surgeon accepts a less than perfect position of the fracture.
It can be prevented by seeking treatment promptly and the treating surgeon should accept nothing less than perfect anatomy.
How is mal-union treated?
Mal-union frequently leads to arthritis of the ankle and subtalar joints. Treatment is by fusion of the joints.
What are the chances of avascular necrosis?
Avascular necrosis is rare in type 1 fractures (10%) but is fairly common (up to 90%) in type 3 fractures.
What is done when avascular necrosis develops?
Avascular necrosis is it's self not a big problem. The problem occurs when after avascular necrosis the body of the talus collapses. This leads to arthritis of the subtalar and ankle joints. This arthritis requires fusion of the joints.
Collapse after avascular necrosis does not always occur. Even in the presence of avascular necrosis the fracture can unite. After fracture union the avascular body of the talus is protected by using a patellar-tendon bearing brace. Use of this brace is continued till revascularization (blood supply to the talus body develops again) of the talus body occurs. This can take up to 3 to 4 years.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 23th June 2009.
Other causes of foot pain...
Tarsal Tunnel Syndrome
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