Talus fracture

Background

Bones of the foot.

• Almost always associated with other injuries, often misdiagnosed as ankle sprains
• Talar neck fracture most common (~50%)
  • Dorsiflexion with axial loading, snowboarders
• Talar body fracture (~20%)
  • Hindfoot in either supination or pronation, high energy trauma
• Lateral process fracture (~10%)
  • Dorsiflexion with axial loading
• Posterior process, medial or lateral tubercle very commonly misdiagnosed as ankle sprains
• Talar head fracture least common

Clinical Features

• Mid ankle pain/injury

Differential Diagnosis

Foot and Toe Fracture Types

Hindfoot

• Talus fracture
• Calcaneus fracture

Midfoot

• Lisfranc injury
• Navicular fracture
• Cuboid fracture
• Cuneiform fracture

Forefoot

• Fifth metatarsal fracture
• Non-fifth metatarsal fracture
• Toe fracture

Evaluation

Talus and subtalar joint

Talus fracture

• CT often required for accurate diagnosis
• AP, lateral, possibly Canale view

Management & Disposition

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific

• Major fracture (talar neck and head)
  • Immediate ortho consultation required (high rate of avascular necrosis)
• Minor fracture
  • Posterior Ankle Splint
  • Non-weight bearing, short leg cast if minimally displaced fracture
  • Ortho referral

See Also

• Foot Fractures
• Foot Diagnoses (Main)

References

• Weatherford B. Talar neck fractures. Orthobullets, last updated 12/19/14. http://www.orthobullets.com/trauma/1048/talar-neck-fractures.
• Aiyer A, Moore D. Talus Fracture (other than neck), last updated 1secondary to7/14. http://www.orthobullets.com/trauma/1049/talus-fracture-other-than-neck.
• Judd DB, Kim DH. Foot Fractures Frequently Misdiagnosed as Ankle Sprains. Am Fam Physician. 2002 Sep 1;66(5):785-795.