Management of Talar Body Fractures

Abstract

Fractures of talar body are uncommon injuries often associated with fractures of other long bones and in polytraumatized patients. The integrity of the talus is essential for the normal function of the ankle, subtalar, and midtarsal joints. The relative infrequency of this injury limits the number of studies available to guide treatment. They occur as a result of high-velocity trauma and are therefore associated with considerable soft tissue damage. Axial compression with supination or pronation is the common mechanism of injury. Great care is necessary for diagnosing and treating these injuries. Clinically, talar body fractures present with soft tissue swelling, hematoma, deformity, and restriction of motion. Associated neurovascular injury of the foot should be carefully examined. The initial evaluation should be done with foot, and ankle radiographs and computed tomography is often done to analyze the extent of the fracture, displacement, intraarticular extension, comminution, and associated fractures. Differentiating talar neck from body fractures is important. Optimal treatment relies on an accurate understanding of the injury and the goals of treatment are the restoration of articular surface and axial alignment. Indications for nonoperative management are seldom indicated and are few as in nonambulatory patients, or in with multiple comorbidities who are not able to tolerate surgery. Splinting, followed by short leg casting for 6 weeks until fracture union should be undertaken. Surgery is indicated in most of the cases, and different approaches have been described. Sometimes, a dual approach with a malleolar osteotomy is necessary for articular restoration. Clinical outcomes depend on the severity of the initial injury and the quality of reduction and internal fixation. The various complications are avascular necrosis, malunion, infections, late osteoarthritis, and ankylosis of subtalar joint.

Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis

“…It is well known that the different fixation directions and fixation methods of screws are not only the main factors affecting the stress distribution of talus, but also the key factors to promote fracture healing. Several reports have shown that proper internal fixation can provide a good mechanical environment for talus neck fracture and improve the cure rate of talus neck fracture [23,24]. After the fracture of the talus neck was incised and fixed, the stress on the fracture surface is too large, which will lead to an increase in the probability of secondary fracture and even bone resorption.…”

Peroneal tendon dislocation in talus fracture and diagnostic value of fleck sign

“…Another limitation is that functional outcomes of those cases with peroneal tendon dislocation were not uniformly recorded, which precludes comparison to those with talus fractures with no concurrent peroneal tendon dislocation. However, morbidity associated with isolated peroneal tendon dislocation has been described in literature and touched upon earlier in this discussion [17][18][19].…”

“…Chronic dislocation is associated with tear of the peroneus brevis due to attrition against the posterolateral ridge of the fibula. This adds to the morbidity of talus fractures and may lead to inferior outcomes of surgical treatment (17)(18)(19). Another implication of the presence of peroneal tendon dislocation is that it may affect approach selection for open reduction and internal fixation to allow for examination and treatment of the peroneal dislocation while maintaining maximum exposure.…”

Diagnosis and Treatment of Peritalar Injuries in the Acute Trauma Setting: A Review of the Literature

“…Fracture of the talar head is relatively rare, with a described incidence of <10% of talar fractures. is pattern is caused by a combined dorsiflexion and inversion force that longitudinally loads the talus, resulting in a shear fracture across the talar head [16]. As a result, the medial column is functionally shortened, often resulting in a cavovarus foot with abnormal loading of the lateral column.…”

“…Treatment of talar head fractures varies from conservative immobilization to percutaneous pinning and to open reduction and internal fixation of displaced fragments [16]. In cases of late or missed diagnosis, salvage arthrodesis may be an additional option.…”