Talar neck fracture treatment

Talar fractures orthopaedicsone articles orthopaedicsone. The talar avulsion fracture in this patient is also small with only slight displacement and is seen hovering just above the mid to anterior talus. Oct 26, 2017 immediate treatment of a talus fracture includes immobilizing the foot and elevating it above the heart. Bad foot biomechanics, excessive training, illfitting footwear, stiffness in the joint, poor flexibility and weakness of the muscle. Plain radiograph normal ankle ankle mortise ct talar head fracture ct of fracture of the medial process of the talus ct of talar body fracture with dislocation ultrasound talar dome fracture type ii talar neck fracture type iv talar neck fracture radiograph nondisplaced talar neck fracture ct talar neck and body fractures radiograph and ct lateral process talus fracture. The talus bone is a square, flat bone on top of the calcaneus heel bone. It joins with the two leg bones tibia and fibula to form the ankle joint and allows for upward and downward motion of the ankle. One of the most challenging diagnoses for general orthopedic surgeons as well as fracture specialists is a fracture of the talar neck. This will lead to more decisions about further investigation and other forms of treatment. This puts patients with displaced talar neck fracture at risk for the. Talar neck fractures occur infrequently and have been associated with high complication rates. It joins with the two leg bones tibia and fibula to form the ankle joint, allowing for upwards and downwards motion of the ankle. The purposes of the present study were to evaluate the rates of early and late complications after operative treatment of talar neck fractures, to ascertain the effect of surgical delay on the development of osteonecrosis, and to determine the functional outcomes after operative treatment.

You may need surgery if you have a large fracture or your bones are out of place. An open fracture should be treated as a medical emergency. Fractures of the neck and body of the talus present as one of the most challenging and rare injuries. If the fracture is displaced, then it is often associated with other hindfoot injuries. If the fracture is not out of position, a cast may be sufficient for treatment. Oct 05, 2018 repeated overpronation and plantar flexion of ankle. Jul 31, 2017 a fracture of the talar body is a serious injury because the fracture involves the ankle joint.

Pins or screws may be needed, as well as treatment of the damaged muscles and other tissue. Apr 09, 2020 significant softtissue disruption is frequently associated with highgrade talar neck fractures. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons. The splint should extend from the toe to the upper calf. Jul 04, 2018 intraoperative images of the surgical treatment of a talar neck and body fracture in a 42yearold male who fell from a ladder continued from fig. The treatment of a displaced talar neck fractures is operative talar neck orif unless there is a contraindication to surgery. Talus fractures pediatric orthopaedic society of north. However, if it is as demonstrated on the ct scan it may be treated nonsurgically with nonweightbearing and immobilization for 68 weeks until healing of the fracture is documented. A pivotal jbjs article in 1978 focused attention on these vexatious injuries. The goal of talar neck fracture treatment is anatomic reduction of both the neck and subtalar joint, because even minimal residual displacement can adversely affect subtalar joint mechanics. In this situation, aligning the cortical margins of the fracture will.

Clinical results of 50 patients gholam pajenda, md, vilmos vcsei, md,1 brian reddy, md, and thomas heinz, md1 fractures of the neck and body of the talus present as one of the most challenging and rare injuries. The clot may travel to your heart or brain and cause lifethreatening problems, such as a heart attack or stroke. A talar fracture is a break in the talus bone that often involves both of these important joints. The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot figure 1. Bone without blood supply and nourishment will necrose, causing the bone to collapse 1. Various surgical approaches and fixation methods have been documented. Talar fracture surgery is needed if the bone has shifted or broken through skin, if the nerves or blood vessels are damaged, or if there is an uneven cartilage surface in the ankle or subtalar joints. Treatment for the minimally displaced or stable fracture can sometimes be treated with immobilization such as a cast. Talar neck fractures pose treatment challenges with both initial injury and potential sequelae. Surgical treatment of talar neck and body fractures. Talus fracture causes, types, symptoms, complications. Immediate first aid treatment for a talus fracture, as with any painful ankle injury, is to apply a wellpadded splint around the back of the foot and leg to immobilize and protect the limb.

Talus fracture treatment options the talus is the bone in the back of the foot that connects the leg and the foot. The talar neck itself has fewer trabeculae compared with the head or body, and these trabeculae have a different orientation. Talar avascular necrosis can be significantly disabling and pose a major problem for the average foot and ankle surgeon. Initial treatment of talar dome fractures is often delayed due to the fact that the symptoms of a talar dome fracture are very similar to the symptoms of an ankle sprain.

Provisional reductions of the talar neck and body are held with kirshner wires, and thorough radiographic assessment is undertaken until fracture alignment has been optimized. A fracture of the talar body is a serious injury because the fracture involves the ankle joint. The talus is a bone which is present in the ankle and is small in size. Because the talus is important for ankle movement, a fracture often results in significant loss of motion and function. Dec 03, 20 treatment of talar neck fractures is challenging. The talus is the bone in the back of the foot that connects the leg and the foot. It connects the heel with the lower leg bones to form the ankle. Talus fractures 2 surgical treatment of talar neck fx. Stress fracture of the talus symptoms, causes, treatment. Results of the treatment of talar neck fractures in a west. 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 longterm followup. Talar neck fractures comprise over half of all injuries to the talus. Because the talus is so important for ankle movement, a fracture often results in substantial loss of motion and function.

A talus fracture often occurs during a highenergy event like a car collision. The risk of avascular necrosis in talar neck fractures is 10% or less if the fracture is not displaced. Other than the ankle joint, it also forms joints with other small bones such as navicular and calcaneus. However, if this fracture is part of the spectrum of talar neck injuries which presents with displacement, requiring reduction, then there may be more decisions to be made about investigation and forms of treatment. A large portion of the talar dome can be exposed with plantar flexion of the foot. Talar neck fracture orthopedic coding ask an expert. Stress fractures of the talar body, neck and head can progress to occult fractures, and are very analogous to femoral neck stress fractures. Physical exam is notable for ambulation on the lateral border of the right foot with hindfoot varus, midfoot supination and diminished. Fabricus is credited with the first description of a talar neck fracture in 1608. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Surgical management of hawkins type iii talar neck. Operative treatment of displaced talar neck fractures. Displaced talar neck and body fractures are rare and challenging for the surgeon.

Total talar fracture longterm results of internal fixation of talar. Treating occult stress fractures in athletes podiatry today. Treatment for a neck fracturealso called a cervical fracture or broken neckdepends on the severity of the injury, which cervical vertebrae bones in the neck that protect the spinal cord are injured, and if the spinal cord is involved. The talus bone makes up part of the ankle joint and the subtalar joint. May 08, 2017 one of the most challenging diagnoses for general orthopedic surgeons as well as fracture specialists is a fracture of the talar neck. This, however, is unusual as most talar neck fractures present with at least some displacement. These devices prevent ankle movement and help your talar fracture heal. It is and overuse injury, sometimes seen in footballers and track and field athletes. Immediate treatment of a talus fracture includes immobilizing the foot and elevating it above the heart. Immediate first aid treatment for a talus fracture, as with any painful ankle injury, is to apply a wellpadded splint around the back of the foot and leg from the toe to the upper calf to immobilize the limb and protect it. Elevating the foot above the level of the heart helps to minimize swelling and pain. Talar neck fractures extend through the thinnest crosssectional portion of the talus, just proximal to the talar head.

Talus fracture treatment options tricounty orthopedics. This process is often very painful and debilitating, particularly. This type of fracture often occurs during a highenergy event, such as a car collision or a highvelocity fall. Talus stress fracture injuries ankle talus stress fracture also known as talar stress fracture, stress fracture of the talus what is a talus stress fracture. Without treatment, a talar fracture can cause problems with walking and activities, including sports. Pdf current concepts in talar neck fracture management.

Prasad, 20 in higher energy mechanisms with displaced talus fractures, associated sh iv distal tibia fractures have been described. This scenario, however, is the exception and not the rule. Its function is shifting weight from the shin to the foot. You may also need crutches to help you move around. Useful to perdict long term outcome and development of avn of talar body 39. Talus fracture injuries ankle talus fracture also known as talar fracture, talar dome fracture, fractured talus, broken talus what is a talus fracture. Displaced talar neck fractures almost exclusively receive treatment with open reduction internal fixation with. Current concepts in talar neck fracture management ncbi nih. The talus is the bone that makes up the lower part of the ankle joint. 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.

Treatment of comminuted talar neck fractures with use of min. Hawkin classification of talar neck fracture hawkins 1970 talar neck fractures into three type canale and kelly added type iv based on displacement of body of talus. Computed tomography ct scanning is useful to confirm the fracture. The ankle joint allows for upanddown motion and the subtalar joint supports sidetoside motion. Anatomic reduction and restoration of the peritalar articular surfaces are the pillars of talar neck fracture treatment. A 35yearold male fell and sustained an open talar neck fracture.

A closer look at a total talar replacement and ankle. The aim of the study was to evaluate midterm results. A minor compression fracture can be treated with a cervical collar or brace worn for six to eight weeks to immobilize the neck until the break heals. Feb 03, 2020 a talar fracture is a break in the talus bone of your foot. Decarbo avascular necrosis avn or osteonecrosis is defined as a disease resulting from temporary or permanent loss of the blood supply to bone 1.

Treatment usually includes a period of immobilization followed by gradual return to activity. Talus fractures 2 surgical treatment of talar neck fx ota. Nov 10, 2017 narrated, annotated lecture 2 of 4 on talus fractures and dislocations from the ota resident lecture series narrated by saqib rehman, md, from. Apr 21, 2015 hawkin classification of talar neck fracture hawkins 1970 talar neck fractures into three type canale and kelly added type iv based on displacement of body of talus. Disruption of the dorsal cortex of the talar neck is visible, and the fracture line can be faintly followed vertically through the talar neck.

A support device may be the only treatment you need. Plain xrays may be all that is required if the fracture is undisplaced. The most common mechanism of injury in talus fractures is forceful dorsiflexion resulting in talar neck fracture as it impinges against anterior tibial plafond. Major posttraumatic complications with a potential reduction in the quality of life are arthrosis and necrosis due to the specific vascular supply. Displaced lateral talar process fractures typically have a better outcome than talar neck and body fractures.

Sagittal plane articular fractures of the talar body typically require fixation from medial to lateral with lag screws. The talus articulates superiorly with the tibia and fibula in the ankle mortise and the calcaneus and navicular inferiorly. Talar fracture in adults inpatient care what you need to know. The infrequency of displaced talar fractures means that orthopaedic residents receive relatively little training in this area. For closed talus fracture treatment not requiring manipulation, see 28430. Surgery to treat an open talus fracture often involves much more than lining up the broken pieces of bone. They often require fixation to prevent propagation of the fracture or displacement. These fractures are often associated with other ankle, foot.

Obtaining satisfactory clinical outcomes with minimum. Jan 11, 2020 treatment of a talus fracture depends on the extent of the injury. Ct talar head fracture ct of fracture of the medial process of the talus ct of talar body fracture with dislocation ultrasound talar dome fracture type ii talar neck fracture type iv talar neck fracture radiograph nondisplaced talar neck fracture ct talar neck and body fractures radiograph and ct lateral process talus fracture. If the fracture is out of position, then surgery may be recommended to realign the broken bones and stabilize them with screws or pins. This permits placement of screws in an extraarticular location from the firm cortical bone of the lateral aspect of the talar neck into the posterior part of the talar body figs. Because the talus is important for ankle movement, a fracture often results in. Patients with a talar body fracture will have a painful, swollen ankle and will be unable to bear weight on their injured extremity.

The complexity of fractures of the talar neck and difficulty of treating them are often reflected in the literature. The goal of surgery is to return the talus to its original position prior to the fracture. If these patients continue to bear weight, talar neck fractures can essentially become hawkins ii fractures very quickly. They represent one of the most common types of talus fracture 3050%, along with chip and avulsion fractures of the talus 4049%. Most talus fractures, particularly displaced fractures require operative treatment in the form of surgical reduction with screws.

A talus fracture is a condition characterized by a break in one of the small bones of the ankle, known as the talus figure 1. Functional outcomes following displaced talar neck fractures. Treatment usually involves six weeks immobilization in a plaster cast. A talar fracture is a break in the continuity of one of the bones that forms the ankle. These fractures are commonly associated with subtalar dislocation andor. Results of the treatment of talar neck fractures in a west african hospital 29 references 1. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. Sep 01, 2011 the goal of talar neck fracture treatment is anatomic reduction of both the neck and subtalar joint, because even minimal residual displacement can adversely affect subtalar joint mechanics. Talus fractures 2 surgical treatment of talar neck fx ota lecture series iii l14b. Code 28436 describes talus fracture treatment that involves manipulation and percutaneous surgery for fixation, but does not involve an incision to expose the bone. Talus fracture types everything you need to know dr. To assess the healing and radiographic outcomes of displaced and comminuted talar neck fractures treated with medial position screws augmented with lateral. Talar body fractures with coronal displacement, comminution, or an associated talar neck fracture are most accurately addressed through dual anteromedial and anterolateral surgical approaches figs.

Treatment of displaced talar neck fractures using delayed. Ct is the imaging modality of choice to fully identify the fracture pattern and associated injuries. It is very rare for a talar neck fracture to be truly nondisplaced. Fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. Stress fracture of the talus is a hairline fracture in the ankle. Talar fracture in adults inpatient care what you need. The most common etiology of talar avascular necrosis is a talar body or neck fracture. Excessive weight bearing and force to the ankle such as seen in running. Surgery to remove the lateral process of the talus bone is sometimes done, as. Nov 09, 2018 hawkins type i fracture of the talar neck, lateral radiograph. Following talar neck fracture, osteonecrosis of the talar body is associated with the amount of the initial fracture displacement, and separating hawkins typeii fractures into those without type. Talus fracture other than neck trauma orthobullets. It connects with these bones and forms the ankle joint. Diagnosis is difficult and treatment is even more challenging.