Talus Fractures: An Update on Current Concepts in Surgical Management

Michael Githens, MD; Jennifer Tangtiphaiboontana, MD; Kurtis Carlock, MD; Sean T. Campbell, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(15):e1015-e1024. 

In This Article

Abstract and Introduction

Abstract

Talus fractures can be challenging injuries to treat because of complex talar shape, an abundance of articular cartilage, a potentially unforgiving soft-tissue envelope, and an easily injured blood supply. In addition, the spectra of energy involved, soft-tissue injury, and the fracture pattern are wide. Temporizing treatment is sometimes required, including débridement of open fractures, reduction of dislocations, and occasionally spanning external fixation. Definitive treatment first requires an understanding of the fracture pattern, including location and fracture line orientation. Multiple options for surgical exposure exist and are selected based on the fracture pattern and condition of the soft tissues. Newer fixation techniques, including the use of fixed-angle and minifragment implants, are useful in achieving stable fixation.

Introduction

The talus can be a particularly challenging bone to treat surgically for fracture for a number of reasons. Its blood supply arises from an anastomotic sling that is easily injured and has implications on surgical approaches, reduction strategy, and outcomes after treatment. Its complex three-dimensional osteology is unique, including a distinct head that articulates with the navicular joint, a body that articulates with the tibial plafond, distal fibula, and calcaneus, and an axially asymmetric neck that joins the two. Restoration of this complex shape can be confusing to an unfamiliar surgeon. In addition, because of its multiple articulations, a notable portion of the exterior of the talus is cartilaginous, limiting implant options. An anatomic reduction of the articular surfaces and overall morphology, even in the setting of comminution, is required to restore not only the joint surfaces but also the three-dimensional shape of the talus. Restoring native talar morphology is critical to the normal biomechanical function of the foot and gait cycle. Finally, the talus is constrained within the mortise, and often multiple surgical approaches are required to adequately address the fracture. Careful scrutiny of the imaging and the development of a surgical plan are required for successful surgical treatment of these complex fractures.

Although relatively uncommon overall, talus fractures may still be encountered by any orthopaedic surgeon taking general call. The existing literature provides a broad foundation regarding the anatomy and blood supply of the talus, pathoanatomy of talus fractures, and the management of talar neck fractures. However, recent work has emphasized the importance of peripheral fractures of the talar processes and body and reported on new surgical techniques. The goal of this review is to provide an update on these new developments.

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