The complexity of fractures of the talar neck and difficulty of treating them are often reflected in the literature. Osteochondral fractures of the talus are a possible. Up to 20% of cases present as open injuries with an anterolateral wound at. Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Its function is shifting weight from the shin to the foot. Talar dome fractures occur in upwards of 6% of all ankle sprains. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. May 31, 2017 the talar head is the least common part of the talus to fracture. These lesions can be chronic in nature, as seen in osteochondritis dissecans ocd. Each type of fracture has its own outcome in terms of treatment plan due to its mechanism of injury. Specifically, there was fracture of an adjacent bone in the ipsilateral foot or ankle in 77%, 72%, and 88% of talar body, neck, and head fractures, respectively. Other than the ankle joint, it also forms joints with other small bones such as navicular and calcaneus. Talar head insufficiency fractures should be considered in older patients, particularly perimenopausal women.
Osteochondral fractures of the talar dome are the most common type of body fractures. The mechanism of injury for talar body fractures typically involves. This incision is mostly used for the operative management of talar body fractures. An podiatric surgeon should be consulted for treatment of talar dome lesions because of the high. Talar fracture repair and rehabilitation surgical indications and considerations anatomical considerations. Swelling and tenderness in the dorsal midfoot may be a sign of a navicular fracture, lisfranc injury, or other tarsalmetatarsal injury. Also known as talar fracture, talar dome fracture, fractured talus, broken talus. Once united, still need up to 3 years before revascularisation ptb bracenwb if dome collapse and pain, identify joints involved and arthrodese. We present nondisplaced talar head fractures in two patient groups.
The bones in the ankle joint hit each other damaging the cartilage surface. This kind of fracture generally results froman impaction injury, which damages the articular cartilage and subchondral bone 68, 69 fig. Talar neck fractures are a rare but potentially devastating injury. This type of fracture often occurs during a highenergy event, such as a car collision or a highvelocity fall. Olts have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. Defined as a separation of articular cartilage from the talar dome, with varying amounts of subchondral bone. Procedure selection is generally based on lesion size, location on the talar dome andor a history of prior failed surgical management. Jul 04, 2018 the purpose of this article is to describe both classic and current literature to better understand the evolution of talar neck fracture management. Talar neck fractures comprise over half of all injuries to the talus. At 1 year, there was fracture and collapse of the medial talar dome.
Insufficiency and nondisplaced fractures of the talar head. All patients with a history of both an open fracture and osteonecrosis experienced collapse. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment. Osteochondral fracture of the talar dome radiology case. Stage i, ii, and iii medial lesions can usually be treated nonsurgically with six weeks in a nonweightbearing cast. Acute osteochondral fracture at the lateral corner of the talar dome.
The talus is made up of a body consisting of a dome, central portion, a lateral process, and a posterior process. This represents an important orthopedic injury as it can often go unnoticed on initial radiography with instability of the osteochondral fragment leading to progressive abnormality and secondary degeneration of the joint. Threedimensional reformatted ct image of the talus a and lateral ankle radiograph b show the divisions between the talar head, neck, and body dashed. Pdf management of osteochondral lesions of the talar dome. The talus ranks as the second largest tarsal bone with unique anatomic features and serves an important role in mobility of the foot and ankle as it is the osseous link between the leg and the foot. Management of osteochondral lesions of the talar dome fulltext.
They can be difficult to diagnose and even more difficult to treat. Talar fracture repair and rehabilitation amazon s3. Arthroscopic treatment of transchondral talar dome fractures. Talar fractures orthopaedicsone articles orthopaedicsone. Management of fracture neck of talus and clinical evaluation.
A proposed treatment algorithm for osteochondral lesions of. Adultacquired flatfoot deformity is a progressive flattening of the arch of the foot that results from posterior tibial tendon insufficiency with a predilection for middleaged women. Fracture may not appear for 2 to 4 weeks after injury. Fractures of the talar dome may be difficult to detect in standard radiographs. Figure 2 demonstrates similar findings in a patient 8. Management of osteochondral lesions of the talar dome. Lateral lesions generated when the anterolateral talar dome impacted the fibula during inversion and dorsiflexion. Foot fractures that are frequently misdiagnosed as ankle sprains.
Five of these ten patients experienced collapse of the talar dome at a mean of 10. If the fracture line is anterior or inferior to the lateral process of the talus and the talar dome cartilage, it is classified as a talar neck fracture fig 4 15. The orthopedic specialist will advise the patient as to which management is most appropriate based on a number of factors, including the location, severity and type of the fracture. Flake fractures of the talar dome involving the cartilaginous surface and subchondral bone have been called. To distinguish between neck and body fractures, talar body fractures are now defined to include all injuries to the talus that produce a fracture line at or posterior to the lateral tubercle of the talus. The accepted mechanism of talar neck fractures is a hyperdorsi. The fracture classification developed by berndt and harty is widely used to stage talar dome lesions. Ankle injuries and talar neck fractures are almost always the result of a high energy trauma.
Talar fractures and dislocations rsna publications online. Some have advocated closed treatment of type i fractures of the talar neck if a fracture is nondisplaced or if an anatomic reduction can be maintained by closed means. Oct 26, 2017 a talus fracture usually results from serious trauma to the foot. An osteochondral lesion of the talar dome is a condition characterized by damage to the cartilage and or bone surfaces of the upper superior aspect of the talus bone i. It can be caused by a traumatic traction repetitive longterm or a single high impact traumatic traction of the ligament or tendon. Talkhani and colleagues 154 reported a case of avn of the talus after a minimally displaced talar neck fracture in a 6yearold child. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment required to achieve a satisfactory result. A talar fracture is a break in the continuity of one of the bones that forms the ankle. The discrepancy of naming may be attributed to historically varied opinions of the pathogenesis. Anatomy the talus articulates superiorly with the tibia and fibula in the ankle mortise and the calcaneus and navicular inferiorly. Surgical management was recommended for lateral talar. It is important to distinguish between talar neck fractures and talar body fractures because the treatments and prognosis differ. Anatomic reduction of a type ii or iii fracture often requires.
Well explain the types, how theyre treated, and the recovery timeline. The philosophy and opinions of the author cannot be construed as reflecting official us army medical department policy. Talar neck fracture osteonecrosis primary goal is union, which still occurs, therefore continue nwb, even if no hawkins sign. Compression fractures of the talar dome may be radiographi cally occult, and patients are often given the diagnosis of an ankle sprain. They are usually sustained when the foot is plantar flexed and there is a forced axial load. Foot fractures frequently misdiagnosed as ankle sprains. A calcaneus fracture is a disabling injury that occurs when one or more bones of the heel, fractures. The reason for nonsurgical treatment of medial talar dome fracture stage. Osteochondral lesion of the talar dome physioadvisor.
Sep 01, 2002 the dome of the talus articulates with the tibia and fibula, and has a key role in ankle motion and in supporting the axial load during weight bearing1 4 figures 1 and 2. The full text of this article is available in pdf format. Management of osteochondral lesions of the talar dome article pdf available in the open orthopaedics journal 11suppl4, m15. Fracture of the lateral process of the talus in snowboarders. The ankle joint is formed by the articulation of the tibia, fibula and talus bones figure 1. The breakdown of talus fractures is quite complex because although authors are in. It connects with these bones and forms the ankle joint. They also proposed a specific treatment of curettage and filling with bone material. Talar neck fractures are usually the result of high. Ap radiograph of the foot a and oblique axial reformatted ct image b show. 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. Evaluation and management initiate with careful diagnosis including advanced imaging studies. Oct 17, 2016 talar dome fractures occur in upwards of 6% of all ankle sprains. Recent findings urgent reduction of displaced fractures and dislocations remains the standard of care to protect the soft tissue envelope and neurovascular structures.
One of the bones comprising the ankle is the talus bone which forms part of the foot. This type of fracture often occurs during a highenergy event, such as a car collision or a fall from a significant height. It can occur at numerous sites in the body, but some areas are more. A talar dome injury also know as osteochondral lesion is cartilage damage of the ankle that can occur from a traumatic fracture or ankle sprain. The upper part of the talus is called the talar dome. Talar body fractures are defined by an inferior fracture line located within or posterior to the lateral process. The most common complication after talar neck fracture is pta. Regardless of the talar fracture location, there was a high association of adjacent fracture or disruption of the talar articulations in all three main anatomic types of talar fracture. The entire length of the fibula should be palpated to rule out an associated proximal fracture maisonneuve injury. Osteochondral lesions of the talus olts are a difficult pathologic entity to treat. Bilateral stress fractures of the talus associated with.
Gentry 2, phinit phisitkul 1, 1 department of orthopaedics and rehabilitation, university of iowa hospital and clinics, 200 hawkins drive, iowa city, ia, 52242. Learning objectives the continuum of outcomes following. Management of osteochondral lesions of the talar dome chamnanni rungprai 1, 3, joshua n. A talus fracture usually results from serious trauma to the foot. In addition, a talus fracture that does not heal properly can lead. Hence, this fracture is also known as a heel bone fracture of the calcaneus. Osteochondral lesions of the talar dome can cause significant functional impairment and a decreased quality of life. Because the talus is important for ankle movement, a fracture often results in significant loss of motion and function. Reported indications for arif include transchondral talar dome fracture, talar fracture, lowgrade fracture of the distal tibia, syndesmotic disruption, malleolar fracture, and chronic pain. They tend to be intraarticular injuries and may extend to the neck and body. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. A talar dome lesion is an injury to the cartilage and underlying bone of the talus within the ankle joint.
The diagnosis, management and complications associated with. The talus is a bone which is present in the ankle and is small in size. Talar dome examination palpation specific location of tenderness proximal fibula anterior process of calcaneus mechanism of injury similar to ankle sprain inversion lateral process of talus talar dome be specific several structures in small area. Talar dome fracture causes, symptoms, diagnosis, treatment. Additional and relevant useful information for talus fracture. Ankle injuries and talar neck fractures are almost always the result of a highenergy trauma. Talar dome injury the dome of the talus articulates with the tibia and fibula, and has a key role in ankle motion and in supporting the axial load during weight bearing. Classifying talar dome injuries talar dome lesions occur in 6. Fractures of the talar dome may be medial or lateral, and they are usually the result of inversion injuries, although medial injuries may be. Talus fracture other than neck trauma orthobullets.
The anatomy of the talus is quite complex with three separate articulations with distinct features including the subtalar joint with its three faces. If the fracture line is anterior or inferior to the lateral process of the talus and the talar dome cartilage, it is classified as a talar neck fracture. Delays in treatment can result in longterm disability and surgery. It is also one of the bones that makes up the ankle joint. Talar body fracture definitionfractures of the talar body are intra articular injuries in which the articular surfaces of the tibiotalar and the subtalar joints are involved. Mechanism of injury talar neck fractures are usually the result of highenergy trauma because the thick subchondral bone requires high forces to produce a fracture. Nondisplaced talar head fractures may occur in younger patients after trauma. Therefore, arthroscopic surgery could be an alternative treatment for this kind of talus fracture. Significant softtissue disruption is frequently associated with highgrade talar neck fractures. Introduction the heel bone of horse was used as dice and was called taxillus. Pdf current concepts in talar neck fracture management. Radiographic lateral xray views fractures extending into or posterior to the lateral process of the talus are defined as talar body fractures, whereas fractures. The accuracy of closed reduction of displaced talar neck fractures can be very difficult to assess.
Fabricus is credited with the first description of a talar neck fracture in 1608. Foot fractures that are frequently misdiagnosed as ankle. A lateralized force vector associated with hindfoot valgus in adultacquired flatfoot produces lateral ankle pain due to impingement at the lateral hindfoot, which can even lead to stress fractures of the distal. Threedimensional reformatted ct image of the talus a and lateral ankle radiograph b show the divisions between the talar head, neck, and body dashed lines. It derives the name dome because it sits cradled on top of the calcaneus with the top portion of the bone forming a dome like structure to allow for the up and down motion of the foot.
54 1039 174 161 836 1236 673 1214 935 1324 1110 146 1493 1264 274 651 1298 731 386 1493 481 467 1281 174 1397 1044 926 1036 302 721 469 1358 41 834 642 722