TALAR FRACTURES

DR. TARUN KUMAR BADAMPG DNB ORTHOIORAS

OSSEOUS ANATOMY OF TALUS❖ Talus is one of the 7 tarsal bones of the foot❖ It acts as a connecting link between the Foot and

the Leg❖ It is unique as 60% of it’s surface is articular,

which articulates with Tibial plafound, Medial malleolus, Lateral malleolus, Calcaneum, and Navicular bones

❖ It has Ligamentous and Capsular attachments, but no muscular attachments

In Greek Mythology, Talos was a giant God with single large vein coursing through his body.Because of this vulnerable vascularity, his

crucial weakness was ease of exsanguination

❖ Talus has A. HeadB. NeckC. BodyD. Lateral ProcessE. Posterior Process

❖ Head is intra-articular• Anteriorly : NAVICULAR

bone• Inferiorly : Sustentaculum

Tali of Calcaneum

❖ Head is supported inferiorly by Plantar Calcaneo-navicular or Spring ligament

❖ All three together form Talo-Calcaneo-Navicular joint

❖ NECK is non-articular❖ It forms 15˚ angulation

medially with the body❖ Medial - Sinus Tali

corresponds with Sinus Calcani to form TARSAL CANAL

❖ Lateral - tarsal canal opens into funnel shaped TARSAL SINUS

❖ BODY :• Superior surface• Inferior surface

❖ LATERAL PROCESS : • Wedge shaped• Superiorly and Laterally -

Lateral malleolus• Inferiorly and Medially -

Calcaneum

❖ POSTERIOR PROCESS :• It has Medial and Lateral

tubercle• FHL in b/n• Lateral : Anterior, Lateral,

and Posterior Talofibular Ligament

• Medial : Deltoid ligament• OS TRIGONUM - seen in

50% people, develops from separate ossification centre posterior to Lateral tubercle

VASCULAR ANATOMY OF TALUS❖ Talus 60% of it’s surface is articular❖ It receives blood supply through Capsular and Ligamentous attachments, and

Nutrient foramen in the Neck

❖ Talus is supplied by A. Anterior Tibial artery - Dorsalis Pedis arteryB. Posterior Tibial artery - Posterior tubercle artery - Artery of Tarsal Canal - Deltoid arteryC. Peroneal artery - Artery of Tarsal Sinus

MEDIAL LATERAL

❖ Head and Neck - by DPA ❖ Body - Medial 1/3 - Deltoid lig - Middle 1/3 - Artery of Tarsal Canal - Lateral 1/3 - Artery of Tarsal Sinus❖ Posterior tubercle - Branches from Posterior Tibial artery

❖ Crucial Anastomotic Sling is formed in the Tarsal canal b/n Artery of Tarsal canal and Artery of Tarsal Sinus

❖ It gives branches to the Body of Talus from Distal to Proximal

❖ In # Neck of Talus, this is disrupted leading to Osteonecrosis of Body of Talus

TALAR FRACTURES

❖ 2nd most common tarsal # after Calcaneal #

CLINICAL EXAMINATION❖ Patients presents with h/o trauma ❖ Followed by c/o Pain and swelling of the hind

foot❖ Restriction of movements of the ankle❖ O/E : Tenderness over Talus and Subtalar joint

: Restriction of Ankle and Subtalar movements

RADIOLOGICAL EXAMINATION

❖X- RAYS1. AP VIEW2. LAT VIEW3. CANALE VIEW - For better visualisation of neck of Talus

❖ CT SCAN - required to detect the fracture pattern

❖ MRI SCAN - may be done to identify the soft tissue injury

CLASSIFICATION

❖ TALAR HEAD FRACTURES❖ TALAR NECK FRACTURES❖ TALAR BODY FRACTURES❖ LATERAL PROCESS FRACTURES❖ POSTERIOR PROCESS FRACTURES

TALAR HEAD FRACTURES❖ MECHANISM OF INJURY:

• Fall from ht, with Foot in plantar flexion and

compression force along the long axis of the forefootTalo-Calcaneo-Navicular jt

disruption Shortening of the medial

columnLoss of the Medial longitudinal arch

TREATMENT

TALAR NECK FRACTURES❖ Most common type of Talar

Fractures❖ It is so called, if # inferior

line is distal to Lateral process of Talus

❖ AVIATORS ASTRAGALUS : Pilots resting the sole of the foot on the rudder bar in crashing plane at the point of impact causes Hyperdorsiflexion of ankle causing Talar neck #

MECHANISM OF INJURYWith Hyperdorsiflexion, Posterior capsular ligament of

Subtalar jt rupture and Neck of Talus impacts against Anterior edge of Tibia, leading to TALAR NECK #

With continuation of dorsiflexion force, Calcaneus with rest of foot subluxate forward, leading to Subtalar Subluxation

With continuation of dorsiflexion force, Posterior capsular ligaments of ankle jt, Posterior Talo-fibular lig, and Deltoid lig

rupture

Body of Talus is the wedged Postero-medially out of Tibial mortise, b/n Medial malleolus and Tendo-achilles, leading to

Subluxation of ankle jt

With further dorsiflexion, Talo-navicular jt subluxation occurs

HAWKIN’S CLASSIFICATION

❖ Type I : Nondisplaced ❖ Type II : Displaced with Subtalar

Subluxation❖ Type III : Ass with Subtalar and

Ankle subluxation❖ Type IV : Ass with Subtalar, Ankle

and Talo-Navicular subluxation

AVN

TYPE I 0-25%

TYPE II 25-50%

TYPE III 50-75%

TYPE IV 75-100%

TREATMENT

SURGICAL APPROACH❖ Type II, III, IV are difficult to obtain anatomical reduction by closed

reduction

TALAR BODY FRACTURES

❖ It is so called, if # line is proximal to Lateral process of Talus

❖ Incidence of AVN is same in Neck and Body #, but Post-traumatic arthritis is more with Body #

MECHANISM OF INJURY

❖ Axial compression of Talus b/n Tibial Plafound and Calcaneum

❖ Occurs due to fall from height or Motor vehicular accidents

CLASSIFICATION

TREATMENT

CALCANEOTIBIAL FUSION BLAIR TIBIO-TALAR SLIDING GRAFT ARTHRODESIS

Antero-lateral incision Antero-lateral incision

Talectomy done Comminuted # fragments are removed

Posterior Displacement of navicular to come in contact with Tibia

Sliding graft from anterior surface Tibia used to fill the gap

Painless and stable No Posterior displacement of navicular

Decrease in Height and length of foot Foot is not shortened

Ankle and Subtalar jt are lost Subtalar and Talo-navicular jt are intact

Compensatory Midtarsal movements are present

Subtalar and Midtarsal movements are present

LATERAL PROCESS OF TALUS #

❖ Lateral process # occurs on EVERSION OF DORSIFLEXED AND AXIALLY LOADED FOOT

❖ Seen in Snowboarding injuries❖ Lateral process has attachments to Anterior, Lateral and

Posterior Talo-fibular ligaments❖ V-sign for Radiographic diagnosis

HAWKINS CLASSIFICATION

TREATMENT

POSTERIOR PROCESS OF TALUS #

❖ Posterior process of Talus has Medial and Lateral tubercles with FHL passing in the groove

❖ Medial tubercle - Deltoid Lig❖ Lateral tubercle - Posterior

Talofibular lig

MECHANISM OF INJURY

❖ Medial tubercle of Posterior process # - Forceful eversion of the ankle

❖ Lateral tubercle of Posterior process # - Forceful inversion of the ankle

TREATMENT

❖ Undisplaced - Conservative❖ Displaced - ORIF with Herbert screw fixation

Lorem Ipsum Dolor

COMPLICATIONS OF NECK OF TALUS #

1. OSTEONECROSIS of Body of Talus :

in # neck of Talus, Due to loss of blood supply

- TALECTOMY + TIBIOCALCANEAL FUSION

- BLAIR TIBIO-TALAR SLIDING GRAFT ARTHRODESIS

2. Post-traumatic Arthritis

3. Malunion of Neck of Talus

- CORRECTIVE OSTEOTOMY OF NECK

4. Skin necrosis

HAWKIN’S SIGN

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