Talus fractures

Last updated: May 27, 2022

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Talus fractures are rare and make up less than 1% of all fractures. They are generally caused by high-energy trauma (e.g., due to motor vehicle collisions) or axial loading injuries (e.g., snowboarder's ankle). Talus fractures are classified according to their anatomical location as head, neck, body, osteochondral, lateral, and posterior process fractures. Clinical features include acute pain or tenderness around and/or below the ankle, swelling and ecchymosis around the ankle, restricted range of motion, and inability to bear weight on the affected ankle. Plan x-ray series are usually diagnostic, but a CT scan may be necessary to assess the articular involvement and characterize the fracture. Conservative treatment is recommended for stable and nondisplaced fractures and typically involves a non-weight-bearing, short leg cast for 6–8 weeks. Surgery is the definitive treatment, indicated especially for open or displaced fractures. Complications include avascular necrosis, posttraumatic arthritis, and union issues (e.g., malunion, nonunion).

Epidemiological data refers to the US, unless otherwise specified.

  • High energy trauma: fall from a height, motor vehicle collision
  • Axial loading: sports injuries (esp. snowboarder's ankle)
Classification of talus fractures [1][2]
Type Characteristics Mechanism of injury

Osteochondral talus fracture

  • Trauma-related
  • Non-trauma-related (e.g., osteochondral fragment separation) or due to repetitive microtrauma
  • Medial talar dome fractures are equally associated with traumatic and nontraumatic causes, while lateral talar dome fractures are more commonly associated with traumatic causes.
Talar head fracture
  • Fracture involving the talar articular surface at the talonavicular articulation
  • Associated with adjacent fractures, talonavicular subluxation or dislocation of the talus
  • Trauma-related: axial loading on the plantarflexed foot
Talar neck fracture
Talar body fracture
Lateral talar process fracture
Posterior talar process fracture
  • Forced plantarflexed or inverted foot
  • Forced dorsiflexed foot

Physical examination

Imaging [2]

Conservative

Surgical [2]

We list the most important complications. The selection is not exhaustive.

  • Talar head fractures have a better prognosis than talar neck fractures
  • Hawkins sign: subchondral radiolucency of the talar dome secondary to subchondral atrophy
    • Usually seen 6–8 weeks after injury
    • A negative sign indicates inadequate vascularity of the talus
  • Hawkins-Canale classification: classification system for talar neck fractures with high prognostic value, as the degree of malalignment correlates with the risk of avascular necrosis
Hawkins-Canale classification
Type of fracture Risk of avascular necrosis
Hawkins I Nondisplaced fracture 0–5%
Hawkins II Talar neck fracture and subtalar dislocation or subluxation 20–50%
Hawkins III Talar neck fracture and subtalar and tibiotalar dislocation or subluxation 100%
Hawkins IV Talar neck fracture and subtalar, tibiotalar, and talonavicular dislocation or subluxation 100%
  1. Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB. Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification. RadioGraphics. 2015; 35 (3): p.765-779. doi: 10.1148/rg.2015140156 . | Open in Read by QxMD
  2. Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains.. Am Fam Physician. 2002; 66 (5): p.785-94.

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