Current concepts in talar neck fracture management ncbi nih. We used the medial approach in 17 other patients with. Talus fractures 2 surgical treatment of talar neck fx ota lecture series iii l14b duration. Surgical management of hawkins type iii talar neck fracture through. The complexity of fractures of the talar neck and difficulty of treating them are often reflected in the literature. Anatomic reductions of the talus are often necessary as the blood supply to the talus can be affected by fractures and majority of the talus has articular cartilage. With an open talar fracture, the wound was used as the primary surgical access after initial extensive debridement had been performed. Osteochondral defects of the talus embody a broad category of injuries from fibrillation of the articular cartilage to full depth loss of cartilage and bone. Peroneal tendon dislocation in talus fracture and diagnostic. In cases of unsatisfactory reduction a surgical approach was made depending on the fracture localisation table 2.
A new surgical approach of grooving the distal tibial articulation for the somewhat posteriorally placed medial lesions has been utilized with no untoward effects. Surgical treatment is focused on either fixation or excision of the bony fragment. Management of osteochondral lesions of the talar dome. Fractures and dislocations of the talus and calcaneus.
Dec 22, 2009 in cases of unsatisfactory reduction a surgical approach was made depending on the fracture localisation table 2. Most of the blood supply runs along the neck of the talus, with the neck being the most common fracture site. Mechanism talar body injuries often result from high energy trauma, with the hindfoot either in supination or pronation. The blood supply to the talus is very compromised with a fracture dislocation. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. Talus fractures are relatively uncommon injuries and can be challenging to treat. Feb 27, 2020 talus fractures are relatively uncommon injuries and can be challenging to treat. Jul 14, 2017 fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes. The fracture has healed and she now has symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion.
There is no dogmatic way to approach all fractures and surgical algorithms are inadequate to include all variations of the injury. Fracture care for the community orthopedist and orthopaedic pa. Operative treatment of talar neck frx wheeless textbook of. The rationale behind surgical approaches to ankle fractures. The talus is the bone in the back of the foot that connects the leg and the foot. Anatomic reduction and rigid fixation of articular talus fractures remains the mainstay of treatment to avoid alteration of contact pressures between the ankle and hindfoot articulations and minimize the risk of osteonecrosis. Dual incision approach with plate and screw fixation has become the modern surgical strategy of choice to accomplish these.
Osteochondritis dissecans of the talus transchondral. Talus fracture other than neck trauma orthobullets. Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. Most talus fractures, particularly displaced fractures require operative treatment in the form of surgical reduction with screws. The surgical approaches to the talus must allow access for fracture fixation. The surgical approach to the lateral process of the talus is through an anterolateral incision just anterior and inferior to the tip of the lateral malleolus fig. Youll have the advantage of the latest surgical and nonsurgical procedures in back and neck pain. Anatomic reduction and restoration of the peritalar articular surfaces are the pillars of talar neck fracture treatment. Longterm followup after surgical treatment of talar fractures. This scenario, however, is the exception and not the rule. For joint fractures body of talus, one is generally satisfied once the visible part. Talus approach posterolateral approach to the hindfoot.
A talar fracture is a break in the talus bone of your foot. Eight of the 22 ankles suffered concomitant lateral ligament injuries, peroneal tendon damage, or. We help you diagnose your talus case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Because the talus is important for ankle movement, a fracture often results in significant loss of motion and function. A large portion of the talar dome can be exposed with plantar flexion of the foot. Fixation of the fracture was done in 7 patients through the wound only.
Surgical approaches destroy part of the blood supply, and the surgeon should respect the soft tissues. This incision should start at the medial malleolus, extend over the talar neck medial to the tibialis. Treatment options talus fractures may be treated in a cast, or surgery may be recommended. This results in chronic pain and for this reason a surgical approach is usually necessary. The talus is a small bone at the ankle joint that connects the heel bone and the shin bones. Review of the literature and new surgical approach for medial dome lesions a. Talus fractures outline orthopaedic trauma association. In 3 patients, a combination of the anteromedial and lateral approaches was used. Michael swords, john shank, and stephen benirschke.
Surgical management of hawkins type iii talar neck fracture. Surgical approaches to the talus should allow access for fracture fixation, resection of osteophytes, treatment of osteochondral lesions, removal of painful os trigonum, and resection of hindfoot. A comparison of surgical approaches for osteochondral lesions of the talus associated with ankle fractures jiling sun1, lanling li2, jianxun yang3, yang chen3, wenlong ma2 1nursing office, linyi peoples hospital, linyi 276000, shandong province, p. Since that time, numerous advances have been made regarding surgical approaches and methods of fixation. The orthopedic surgeon will realign the bones and use metal screws to hold the pieces in place. The ankle joint allows for upanddown motion and the subtalar joint supports sidetoside motion. Fractures of the talar neck are relatively uncommon yet current interventions suffer from a high incidence of complications and poor functional outcomes.
Surgical technique surgical approach a two incision technique should be utilized to ensure anatomic reduction of all talar neck and body fractures. The talus bone is a square, flat bone on top of the calcaneus heel bone. Even with accurate and appropriate surgical care morbidity is common. Ankle fractures are a common occurrence on general trauma lists and a confident knowledge of the anatomical considerations for stability will determine which surgical approach to use for which fracture, which is vital to ensure optimum treatment for the injury. A stepwise approach for osteochondral lesions of the talus. Fabricus is credited with the first description of a talar neck fracture in 1608. In this study, urgent reduction of fractures and delayed orif were performed with plate and screws through dual surgical approaches. Talus fracture types everything you need to know dr.
A cast will hold the bones in your foot in place while they heal. Fractures of the talus present significant surgical hurdles for the foot and ankle surgeon. Well explain the types, how theyre treated, and the recovery timeline. After reduction and fixation of the talus injury, reduction and. Talar surgery puts the talus bone back together as best as possible. Treatment of displaced talar neck fractures using delayed. Orif screw fixation talus, displaced neck fractures ao surgery. Surgical technique posterolateral approach for open reduction and.
Talus fractures philipp leucht, md stanford university school of medicine orthopaedic trauma course for nppas ota 20 outline anatomy surgical approaches fixation strategies outcomes and complications anatomy bone 6070% articular cartilage no muscular attachments complex articulations anatomy vascular 1. Talus fracture often occurs during a highenergy event, such as a car collision or a highvelocity fall. She sustains a talus fracture with associated dislocation of the subtalar joint and maintained congruence of the tibiotalar and talonavicular joints as shown in figure a. Stable, wellaligned fractures, however, can often be treated without surgery. Talus fracture is a break in the talus bone that forms the ankle. Treatment numerous surgical approaches have been described for talar neck fractures. Talus fracture treatment options tricounty orthopedics. Please vote below and help us build the most advanced adaptive learning platform in medicine.
The earliest report of osteochondritis dissecans ocd was published in 1888 by konig, who characterized a loosebody formation associated with articular cartilage and subchondral bone fracture. Ultimately, the soft tissue envelope condition, the extent of the talar neck fracture, and associated other injuries plafond, malleoli, foot will dictate the surgical approach chosen. Talus fractures 2 surgical treatment of talar neck fx. Osteochondritis dissecans of the talus transchondral fractures of the talus. It is important to know the anatomical layout of the blood supply in order to estimate the extent of the blood supply sacrifice according to the supposed lesions due to the trauma.
Oct 26, 2017 a talus fracture usually results from serious trauma to the foot. Mar 17, 2020 peroneal tendon dislocation is associated with as high as 20% of talus fractures. Jul 04, 2018 ct is the imaging modality of choice to fully identify the fracture pattern and associated injuries. Review of the literature and new surgical approach for medial dome lesions show all authors a. The skin incision is over the fourth metatarsal and lines up. The medial approach allows easy access to the talar neck and is commonly used. The surgical approaches to the talus must consider the tenuous circulation to prevent iatrogenic avascular necrosis. Surgical approaches to the talus foot and ankle clinics. Olts have been known historically by varied nomenclature, including osteochondritis dissecans, talar dome fracture, transchondral fracture, and flake fracture. This often requires surgical approaches for debridement and fixation of these. Surgical approaches for talar body fracture austin publishing group.
If there are small fragments of bone, they may be removed and bone grafts used to. Fractures of talus are mainly classified by their location. In 4 of these patients, an additional osteotomy of the medial malleolus was also done. Its the essential piece needed to enable the up and down movement of the foot. In the present study, we report a surgical treatment of hawkins type iii talar neck fracture through the approach of medial malleolar osteotomy and miniplate for fixation and discuss the therapeutic effects after longterm followup. In 1922, kappis described this process in the ankle joint. This type of fracture often occurs during a highenergy event, such as a car collision or a fall from a significant height. Talus fracture causes, types, symptoms, complications. Jun 28, 2017 symptoms are characterized by pain and restricted subtalar motion in young patients. In the present study, we report a surgical treatment of hawkins type iii talar neck fracture through the approach of medial malleolar osteotomy.
The emergency room physician initially misdiagnosed the lesion 43% of the time. Two medial malleolar osteotomies were performed via a posteromedial approach for two talar body fractures in order to increase the visualisation of the talus. This is usually done with a combination of immobilization and then rehabilitation. Complicated fracture patterns combined with joint dislocation of variable degrees require accurate assessment, sound understanding of principles of fracture care, and broad command of internal fixation techniques needed for successful surgical care. Surgical approaches destroy part of the blood supply, and the surgeon should. As a result, talus fractures are often accompanied by other injuries, including dislocation of adjacent joints and fracture of neighboring bones. Over 250,000 doctors use vumedi to improve patient care and grow their practice. Talar body fractures are produced by an axial compression of the talus between the tibial plafond and calcaneus, accounting for % 23% of all talar fractures 5. Surgical approach an anterolateral approach was used for the 32 talar neck and corpus fractures.
Anterolateral approach is usuallyy applied for treatment of talus fracture anteromedial approach is used along with anterolateral approach in order to expose talar neck anteromedial approach combined with medial malleolar osteotomy helps the. Surgical approaches to the talus should allow access for fracture fixation, resection of osteophytes, treatment of osteochondral lesions, removal of painful os trigonum, and resection of. Fractures of the talus include a broad spectrum of injuries and consequently require an individualized approach to their evaluation and management. Osteochondral lesions of the talus olt bring the challenges both of articular cartilage healing and a constrained area of access in the ankle joint. One should always opt for a more comprehensive approach, rather than one which will limit visualization, or lead to excessive softtissue retraction. Talus fracture treatment options the talus is the bone in the back of the foot that connects the leg and the foot. Talus iind most common tarsal fracture 60% coverage by articular cartilage no tendon muscle attachments tenuous blood supply 90% of motion of foot ankle body, neck, head, lat. Surgery to treat an open talus fracture often involves much more than lining up the broken pieces of bone. Surgery is indicated in most of the cases, and different approaches have been described.
There is an increased incidence of talus fracture among snowboarders due to the unique stress placed on the talus when landing from jumps on a snowboard. The talus allows for the upanddown motion of the ankle and is essential for proper movement needed for normal gait. Longterm followup after surgical treatment of talar. It joins with the two leg bones tibia and fibula to form the ankle joint, allowing for upwards and downwards motion of the ankle. The purpose of this study is to present our experience with plate fixation through dual approaches and assess the. Surgical approaches destroy part of the blood supply, and the surgeon should respect the soft tissues surrounding the bone as much as possible. Talus fractures 2 surgical treatment of talar neck fx ota lecture series iii l14b. Our two cases have demonstrated that an arthroscopic approach can be a safe and effective treatment option in patients with a symptomatic talus bipartitus. Apr 21, 2015 anterolateral approach is usuallyy applied for treatment of talus fracture anteromedial approach is used along with anterolateral approach in order to expose talar neck anteromedial approach combined with medial malleolar osteotomy helps the better exposure of talar body. A talus fracture commonly occurs through the neck of the talus or can involve the ankle andor subtalar joint. In addition, a talus fracture that does not heal properly can lead to serious complications, including chronic pain.
This is necessary to restore alignment and allow for the best chances of proper healing and normal movement of the foot and ankle. The unique anatomy of the talus with regard to blood supply and complex surrounding articulations is critical to understand in terms of injury prognosis and surgical planning. Surgery should not be performed in fractures that havent shifted, patients who are sick or elderly and cannot risk having anesthesia, or in patients who have very injured or burned skin over the fracture. A talar fracture is a break in the talus bone that often involves both of these important joints. The anteromedial approach is usually employed in combination with the anterolateral approach in order to obtain an anatomic reduction of displaced and comminuted fractures. Surgical treatment of posteromedial talus fractures. Talus fractures are uncommon, accounting for less than 2. Osteonecrosis is reported in up to half of talar neck fractures, although many of these. Surgical treatment of talus fractures can challenge even the most skilled foot and ankle surgeon. Displaced fractures of the talar neck should be treated with open reduction and. Talus is important because it connect the leg with the foot and the hindfoot. For this reason, many talus fractures require surgery. Because the talus is so important for proper ankle movement a fracture may result in significant loss of motion and function. Fractures of the body of the talus are uncommon and poorly described.
All patients underwent the surgical approach of medial malleolar. The purposes of the present study were to characterize these fractures, to describe one treatment approach, and to evaluate the clinical, radiographic, and functional outcomes of operative treatment. Surgery may be needed for a severe fracture or the bones. Original article a comparison of surgical approaches for. Most fractures of the talus require surgery to minimize later complications. Peroneal tendon dislocation is associated with as high as 20% of talus fractures. The mechanism of injury like a fall of a ladder also suggests a more severe injury like a broken talus or even a broken heel bone, see talk. Special attention is given to the clinical literature that evaluates the timing of surgical management for displaced talus fractures. Talus fractures most commonly occur as a result of a fall or other type of trauma. The majority of prior reports on talus fractures have been limited to case series, that is, level 4 evidence. Several series support delayed definitive fixation for talus fractures, suggesting displaced fractures do not necessitate emergent surgical fixation.
A fracture to the talus bone is suspected based on the location of pain and swelling at the top of the foot, near the ankle. Surgical management of hawkins type iii talar neck. Ziran, md hawkins devised a classification system for talus fractures that provided guidelines for treatment as well as prognosis. Talar body fractures with coronal displacement, comminution, or an associated talar neck fracture are most accurately addressed through dual anteromedial and anterolateral surgical approaches figs. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Surgical experience helps in decision making when one is confronted with a difficult choice in selecting the appropriate surgical approach. In the less common situation where the fracture of the talar neck is not comminuted, one can obtain an anatomic reduction and fixation using only the anteromedial approach. A talus fracture is a break in one of the bones that forms the ankle. According to both kundel and frawley et al careful closed fracture reduction should be attempted as early as possible during assessment in the emergency room. An anteromedial approach can be used for fixation of the medial plates.
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