What is a talus fracture?
The talus is the lower bone that makes up the ankle joint and the top bone that makes up the subtalar joint. The talus also articulates with the navicular bone. Talar fractures typically occur after a fall from a height, a motor vehicle accident, or during sports injuries. There may be an associated dislocation of the ankle, subtalar, and/or navicular joints. Fractures of the talar neck and body are more serious than those of the lateral process (also known as a snow boarders fracture).
What should I do if I think I may have fractured my talus?
If you are unable to bear weight on the injured foot, you will require an X-ray as soon as possible. You should be evaluated by an emergency room or urgent care physician. It is important that compartment syndrome, a serious complication caused by internal pressure build up, is ruled out. Once it is determined that compartment syndrome is not present and there has been no damage to any nerves or blood vessels, it is important that a splint be applied as soon as possible to control swelling. Any lacerations in the skin from the fracture increase the risk of infection and also needs to be treated promptly. A CT scan will usually be taken for peroperative planning.
Do all talar fractures require surgery?
The majority of talar fractures do require surgery. Any talar fracture with an associated dislocation will require urgent reduction, usually in the operating room. Several factors are taken into consideration when determining whether the best course of action is surgery or conservative care. It is imperative to restore the shape of the talus as well as possible to minimize pain and restore function. The operative approach and duration of recovery will depend on the severity of the injury.
The prognosis for lateral talar process fractures is usually very good. The risk of developing arthritis in the subtalar joint is high after having a talar neck or body fracture. There is also a high risk of avascular necrosis associated with a talar neck fracture, where the bone of the talus essentially dies. When a talar fracture is associated with a dislocation of the subtalar joint, avascular necrosis occurs nearly 50% of the time. When a talar fracture is associated with a dislocation of the subtalar joint, ankle joint and the talonavicular joint, avascular necrosis is almost certain.