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Fourteen years follow up of an unclassified Talar body fracture with review of literature
Foot and Ankle Surgery, 2006
Talar body fractures are rare. Four major types of talar neck fractures are known but talar body fractures are rarely described. An unusual case of a sagittal fracture of the body of talus is reported in this article. No similar cases are reported in the English literature to the best of our knowledge. The risk of avascular necrosis is very high and accurate reduction with solid fixation remains the key to better outcome. We discuss the possible mechanism of injury along with review of literature.
Talar Neck Fractures: An Overview
Talar injuries are infrequently encountered in practice as the majority require a high energy force such as road traffic accident or fall from height and they are often presented as complex injuries. Talar neck fracture accounts for half of these injuries. Because of the high rate of avascular necrosis (AVN) and posttraumatic arthritis associated with these injuries, it is difficult to predict the prognosis of AVN with the current classification systems. The anatomical position, difficulty of surgical approaches and its complex blood supply add to the challenges. Early recognition and a robust management plan are essential in treating such injuries. Failure to recognize a displaced talus fracture can result in Osteonecrosis, osteoarthritis, malunion or non-union which affects the hind foot function and results in pain, loss of motion and deformity. The integrity of this bone is vital for the function of the ankle, subtalar and mid tarsal joints. This article is an overview of this challenging injury including the mechanism of injury, classification, management and rehabilitation.
International Orthopaedics, 1978
A total of 218 talar injuries were studied with particular attention to the nature and extent of associated injuries. In 96 patients (44%) there was a fracture of one of the neighbouring bones, viz. 59 fractures of the ankle, 27 of the calcaneum, and 11 of the navicular. Talar injury, ankle fracture, and calcaneal fracture co-existed in 7 patients. Among the cases complicated by ankle fractures 15 were open (25%) .and many affected the trochlea (37%). Thirty-six (61%) of the ankle fractures associated with talar injuries were of the supination type, 8 of the pronation type, 5 of the pronation-external rotation type, and2 of the supination-external rotation type. Of the talar injuries occurring in a supinated foot about half were shearing fractures of the talar neck. Of the 27 calcaneal fractures 11 were compression fractures with depression of the joint surface, whereas the others were non-displaced shearing fractures or avulsion fractures. It is concluded that as a rule the talar injury is not isolated, but associated with a more extensive regional injury and that a supination force is the decisive factor causing a talar injury.
Talus Fractures: A Current Concepts Review of Diagnoses, Treatments, and Outcomes
Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca, 2012
The talus is the key articular segment linking the leg and foot, and as such, is subject to complex loads and may occasionally fracture. Fracture patterns provide clues to the underlying pathomechanics and energy of the injury, both of which can help guide treatment and suggest prognosis. Talus fractures have a wide variety of presentation from low-energy avulsion fractures of the lateral or posterior processes, to high-energy comminuted talar body fractures. Appropriate, expe dient treatment provides the patient the best chance of obtaining a good functional outcome. Treatment relies on appropriate diagnosis, which hinges on clinical suspicion provided by the patient's account of pathomechanics, clinical examination, and radiological workup. This current concepts review discusses the pathomechanics, presentation, workup, treatment, and prognosis of fractures of the talar head, neck, body, lateral process, posterior process, and talar extrusions.
Clinical outcome of fractures of the talar body
International Orthopaedics, 2007
Fractures of the talar body present a great challenge to surgeons due to their rarity and high incidence of sequelae. This study reports the medium-term results of displaced fractures of the talar body treated by internal fixation. Nineteen patients (13 M, 6 F, mean age 31) with talar body fractures were studied retrospectively to assess outcome after operative treatment. The fractures were classified as coronal (11), sagittal (6) and crush fractures (2). Six patients sustained open fractures and two had associated talar neck fractures. Average follow-up was 26 months (range: 18-43). Clinical outcome based on American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring was excellent function in four patients, good in six, fair in four and poor in five. Early complications included two superficial wound infections, one partial wound dehiscence, one instance of skin necrosis and one deep infection. Other complications included delayed union in one, avascular necrosis in seven and malunion in one patient. Talar injuries are serious because they can compromise motion of the foot and ankle and result in severe disability. Crush fractures of the talar body and those associated with open injuries and talar neck fractures are associated with a less favourable outcome. Résumé Les fractures du corps du talus sont difficiles à traiter pour les chirurgiens. Cette étude rapporte le traitement à moyen terme des fractures déplacées du talus par fixation interne. 19 patients (13 garçons, 6 filles d'un âge moyen de 31 ans). Les fractures ont été classées de la façon suivante : fractures coronales 11, fractures saggitales 6 et écrasement, fractures 2. Six patients présentaient une fracture ouverte et deux une fracture du col. Le suivi moyen a été de 26 mois (de 18 à 43 mois). L'évaluation clinique des patients a été réalisée selon le score de la Foot & Ankle Society (AOFAS). Le résultat au niveau de la cheville et de l'arrière pied est excellent sur le plan fonctionnel chez 4 patients, bon chez 6 patients, moyen chez 4 patients et mauvais chez 5 patients. Les complications précoces ont été les suivantes : deux infections superficielles, une nécrose cutanée, et une infection profonde. Les autres complications ont été les suivantes : retard de consolidation chez un patient, nécrose avasculaire chez sept patients et pseudarthrose chez un patient. Les traumatismes du talus sont des lésions relativement sérieuses et peuvent compromettre la mobilité du pied et de la cheville. Lorsqu'il y a association d'une fracture écrasement et de lésions cutanées. De telles fractures entraînent souvent un mauvais résultat fonctionnel.
Journal of clinical orthopaedics and trauma
Fractures of talus are relatively uncommon injuries with majority of them involving the neck region. Talar body fracture in sagittal plane in combination with medial malleolus fracture is very rare with few cases being reported in the literature earlier. We report such an unusual combination in an adolescent, which was treated with open reduction and internal fixation with screws for both talus and medial malleolus. This was followed by physiotherapy and non-weight bearing till the fracture united.
Epidemiological study on talus fractures
Revista Brasileira de Ortopedia (English Edition), 2014
between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Results: analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusion: talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days.
Journal of Orthopaedic Surgery, 2009
Fractures of the talus are rare and generally associated with severe trauma. The mechanism of injury is usually forced dorsiflexion or a fall from a height. Severe talar fractures pose a challenge for surgeons as they are often associated with complications such as avascular necrosis, collapse, malunion, secondary osteoarthritis and pain. This has led some institutions to advocate primary arthrodesis for these injuries. We report an unusual complex fracture of the talus that was successfully managed with open reduction and internal fixation. By restoring a near-normal range of motion and function to a fit, young male, the severely limiting effects of arthrodesis were avoided or at least delayed. We use this case to highlight that primary arthrodesis should only be reserved for cases that fail to respond to open reduction and internal fixation or deteriorate to the point where it is the only reasonable and justifiable alternative.