What to do if the talus is fractured? Differentiate the situation and choose the treatment method

Nowadays, young people seem to be very keen on parkour. You can often see a group of teenagers jumping on buildings in the streets, which is very dangerous. Once you fall from a height, it is easy to cause a talus fracture. So if a talus fracture occurs, how should it be treated?

1. Non-displaced fracture

The fracture should be fixed with a plaster boot for 6 to 8 weeks. Try not to force weight support before the fracture is firmly healed.

2. Displaced fractures

The talar head fracture is often displaced dorsally, and can be reduced by manipulation. Pay attention to fix the posture in the plantar flexion position so that the distal end is opposite the proximal end, and fix it with a plaster boot for 6 to 8 weeks. After the fracture is basically connected, it is gradually corrected to the 90° functional position of the ankle joint, and then fixed for another 4 to 6 weeks, which may achieve a more solid healing. Try not to force weight bearing too early. If there is a large separation in the fracture of the talar body, although manual reduction can be successful, strict fixation for 10 to 12 weeks is required.

If manual reduction fails, calcaneal traction can be used for 3 to 4 weeks, followed by manual reduction. Then, a plaster boot can be used for strict fixation for 10 to 12 weeks. However, because the cartilage surfaces of the upper and lower joints are often damaged when the talus body is comminuted or split, the incidence of traumatic arthritis after healing is high, and recovery is often not very satisfactory. If the posterior process of the talus is displaced, the fracture fragments can be removed if they are not large. If the fracture fragments are large and affect the joint surface more, Kirschner wires can be used for fixation, and a plaster boot can be used for fixation for 8 weeks.

3. Failure of closure reduction often requires surgical incision and internal fixation with screws.

Talus neck fractures account for about 30% of talus fractures. When falling from a height, the foot and ankle dorsiflex at the same time, and the talus neck hits the front edge of the distal tibia, resulting in a vertical fracture. It can be divided into three types:

(1) Type I: vertical fracture of the talar neck with little or no displacement.

(2) Type II talar neck fracture with subtalar joint dislocation. After the talar neck fracture occurs, the foot continues to dorsiflex, the talar body is fixed in the ankle cavity, and the rest of the foot is excessively dorsiflexed, resulting in subtalar joint dislocation.

(3) Type III talar neck fracture combined with talar body dislocation. After the talar neck fracture, the dorsiflexion force continues to act, causing the talar body to rotate inward and posteriorly and dislocate, and lock behind the talar process, often accompanied by a medial malleolus fracture. It is usually an open injury.