Talus Fractures

What is a talus fracture?

talus
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The talus is one of the important bones that forms the ankle joint.   The talus is also a unique bone as over one-half it is covered with cartilage--it serves as an important link between the leg and the foot. The talus moves not only at the ankle joint but also below the ankle (subtalar joint) and in the midfoot (talonavicular joint). Therefore, injuries to the talus can have a significant effect on the motion of the ankle and foot joints.

Talus fractures were almost unheard of a hundred years ago. The first series of talus fractures was described in men who were injured in the British Royal Air Force in the early 1900s. The term 'aviators astragalus' was used to describe these fractures that happened as old war planes made crash landings. Now talus fractures are seen in high-speed car crashes and severe falls.

Signs of a Talus Fracture

Patients who have a talus fracture have significant ankle pain, difficulty bearing weight on the ankle, and swelling around the ankle joint. Patients should have immediate x-ray evaluation to determine if there is a talus fracture, or any other injury around the ankle.

Treatment Options

Treatment of a talus fracture depends on the extent of the injury. If the fracture is not out of position, a  cast may be sufficient for treatment. If the fracture is out of position, then surgery may be recommended to realign the broken bones, and stabilize them with screws or pins.

There are two major complications that commonly occur with talus fractures. These problems are ankle arthritis and osteonecrosis. Other potential problems include infection, nonunion, foot deformity, and chronic pain.

Arthritis is common after a talus fracture because so much of the bone is covered with cartilage.

Arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint. When the cartilage is injured, the normally smooth joint surface becomes uneven. These irregularities can lead to accelerated wear in the joint, and ultimately to arthritis. Even with surgical treatment of a talus fracture, the development of arthritis is common.

Osteonecrosis, or avascular necrosis, is a problem that is found commonly in the talus. Because of an unusual blood supply to the talus bone, a fracture can lead to bone cell death by disrupting the blood supply. If the blood supply to the bone is injured, as is common in talus fractures, the bone cannot heal, and osteonecrosis and nonunion can develop. Even with surgery to realign the bone and hold the fragments in position, a damaged blood supply may lead to this problematic complication.

Recovery From Injury

The recovery from a talus fracture is lengthy, because until the bone is healed, the patient cannot place weight on the extremity.

Therefore, most all talus fractures require a minimum of 8 to 12 weeks of protection from weight. In more significant injuries, the time may be longer. Studies have shown that the ultimate outcome of patients correlates well with the extent of the initial injury.

Only time will tell if a patient is going to develop arthritis or osteonecrosis, therefore, your doctor will obtain periodic x-rays to determine the health of the bone, and the adequacy of healing.

Sources:

Fortin, PT and Balazsy, JE "Talus Fractures: Evaluation and Treatment" J. Am. Acad. Ortho. Surg., March/April 2001; 9: 114 - 127.

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