Talus Fracture


Talus Fracture, Talar Stress Fracture

  • Epidemiology
  1. Incidence: 3-5% of ankle and Foot Fractures
  • Mechanism
  1. Acute Trauma (rare in sports)
    1. High energy foot injury (fall from height, Motor Vehicle Accident)
    2. Severe foot dislocations (associated with talar neck Fracture)
  2. Snowboarder's Fracture (Lateral process Talus Fracture)
    1. Often misdiagnosed as Lateral Ankle Sprain
    2. Occurs with acute dorsiflexion and foot inversion under axial load
  3. Other Fractures
    1. Talar Stress Fracture (rare)
    2. Talar Dome Fracture
    3. Posterior Talar Fracture
    4. Osteochondritis Dissecans of Talus
  • Symptoms
  1. Ankle pain
  2. Unable to bear weight
  • Signs
  1. Ankle and proximal foot Ecchymosis, swelling, tenderness and decreased range of motion
  • Imaging
  1. Initial XRay Imaging (Test Sensitivity 74%)
    1. Ankle XRay
    2. Foot XRay
    3. XRay Foot - Canale View (talar neck view)
      1. Patient with supine and knee flexed with foot planted against table in equinus
      2. Foot everted 15 degrees (pronated, lateral foot raised)
      3. XRay beam at 75 degree angle to the dorsal foot directed down through talus and into Calcaneus
  2. CT Imaging Indications
    1. High index of suspicion for Talus Fracture despite negative XRay
    2. Define Fracture to evaluate articular involvement, comminution and for surgical planning
  • Complications
  1. Subtalar Dislocation (risk of Avascular Necrosis)
  2. Tibiotalar Dislocation (risk of Avascular Necrosis)
  3. Osteochondritis Dissecans of Talus (Avascular Necrosis)
  4. Ipsilateral limb Fracture
  5. Foot Osteoarthritis (50% risk)
  6. Infection (20% risk)
  7. Nonunion (5 to 10% risk)
  • Management
  1. Consult orthopedics or podiatry
  2. Emergency Management
    1. Closed reduction and Splinting (posterior short leg splint with or without stirrup splint) or CAM Boot
    2. Non-weight bearing with Crutches
    3. Emergent surgical intervention if Fracture not reducible
  3. Talar body Fractures
    1. Non-displaced talar body Fractures are treated with non-weight bearing and Casting or boot
    2. Displaced talar body Fractures are often surgically managed
  4. Talar neck Fractures
    1. Emergent orthopedic Consultation if displaced talar neck Fracture
  5. Lateral Process Talar Fracture (Snowboarder's Fracture)
    1. Non-displaced Fracture
      1. Non-weight bearing in boot or cast for 6 weeks
    2. Displaced Fracture
      1. Surgery (typically ORIF)
  6. Talar Stress Fracture
    1. Relative rest, support shoe, walking boot (CAM Boot), or non-weight bearing
    2. Resolution may require up to 6 months
    3. Progressive return to weight bearing
    4. Use Ankle Brace after return to activity
  • References
  1. Kiel (2022) Crit Dec Emerg Med 36(9): 18-9
  2. Feden and Kiel (2017) Crit Dec Emerg Med 31(11): 3-10
  3. Koenig and Clanton in Madden et al (2010) Netter's Sports Medicine, Saunders, Philadelphia, p. 469-70