Fractures of the Talus: Current Concepts

Abstract

Talus fractures continue to represent a challenging and commonly encountered group of injuries. Its near-complete articular cartilage surface, and its role in force transmission between the leg and foot, makes successful treatment of such injuries a mandatory prerequisite to regained function. Familiarity with the complex bony, vascular, and neurologic anatomy is crucial for understanding diagnostic findings, treatment indications, and surgical techniques to maximize the likelihood of anatomic bony union. This review details the structure and function of the talus, a proper diagnostic workup, the treatment algorithm, and post-treatment course in the management of talus fractures. Level of Evidence: Level V, expert opinion.

Patient reported outcome of 33 operatively treated talar fractures

“…The management of talar fractures remains to be one of the most challenging aspects in modern trauma surgery, often leading to a poor functional outcome for the patient [ 5 , 9 , 18 ]. The understanding of the unique anatomy and its role for force transmission in the ankle joint is crucial for a successful treatment [ 5 ]. The evidence regarding the treatment of talar fractures is mainly based on retrospective case series [ 6 , 9 ].…”

“…Ankle distortions during sports (28 %) and road traffic accidents (22 %) emerged to be the most common causes for talar fractures in the patient collective. Most notably due to the associated high force impact to the ankle joint, concomitant injuries were frequently observed [ 5 , 6 , 19 , 20 ]. Patients suffering from a road traffic accident were more likely to sustain a concomitant injury of the ipsilateral lower extremity.…”

“…The timing of surgery is still disputed, since historically immediate operative treatment was recommended to reduce the risk of osteonecrosis with talar neck fractures [ 5 , 21 ]. In the investigated study, timing of surgery did not influence the FAOS of patients with a closed talar fracture.…”

“…A recent retrospective study of 31 operatively treated patients with talar neck and body fractures, also reported, that the operation timing did not influence AVN development and clinical outcome [ 19 ]. The recommendation for the time of fixation of closed talar fractures has changed and the consideration of soft tissue complications as well as surgical experience became more relevant [ 5 , 7 ].…”

“…The radiological data analysis showed an AVN in 10 % of our patients and a PTA rate of 25 % after a follow-up time of 17 months. The AVN rates, reported in the current literature, vary depending on the fracture type, the soft tissue involvement and the period of time the study was conducted [ 5 ]. A systematic review of 340 patients with talar neck fractures reported an overall AVN incidence rate of 26 % [ 18 ].…”