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.

Keywords: Talus; arthritis; arthroscopy; fracture; fractures; malunion; subtalar joint; talar body; talus complications; talus management.

Figure 1

A line diagram showing blood supply of Talus. (a) Anteroposterior view, (b) Inferosuperior view

Figure 2

A line diagram showing Sneppens classification of talar body fractures

Figure 3

Clinical photographs showing variation in presentation (a) Deep abrasion on anterolateral aspect of ankle (b) Internal degloving of skin (c) Large lacerated wound on anterolateral aspect ankle

Figure 4

Clinical photographs showing approaches (a) Anteromedial approach (b) Anterolateral approach (c) Medial approach (d) Lateral approach

Figure 5

Talar body fracture operated by medial approach and medial malleolar osteotomy (a) Clinical photograph showing skin condition at the time of presentation (b) computed tomography view in axial, coronal and sagittal sections showing talar body fracture (c) Clinical photograph showing medial approach (d) Preoperative X-ray ankle joint anteroposterior and lateral views showint talar body fracture (e) C-arm pictures of medial malleolar osteotomy, temporary fixation with k-wire, (f) Intraoperative Canale Kelly view (g) Postoperative X-ray ankle joint anteroposterior and lateral view showing fixation of talar body medial malleolar osteotomy fixation

Figure 6

(a) Preoperative X-ray ankle joint lateral view showing talar body fracture with extrusion posteriorly (b and c) Intraoperative photographs showing dual medial and posterior approach (d) Postoperative X-ray anteroposterior and lateral views showing fixation of talar body and medial malleolar osteotomy

Figure 7

X-ray anteroposterior and lateral views of ankle (a) and CT scan sagittal cut of ankle (b) showing posterior talar body process fracture Sneppens type III (c) X-ray anteroposterior and lateral views of ankle showing that it needed posterior approach and fixation

Figure 8

(a) X-ray lateral view of ankle joint showing talar body comminuted fracture (b) Peroperative photographs showing lateral and medial approach being used for fixation (c) Postoperative X-rays anteroposterior and lateral views showing talar body fixed with mini fragment plate and medial malleolar osteotomy fixed with two screws