MANUAL MINORS
A talus fracture is a serious injury affecting one of the main bones of the ankle, located between the calcaneus (heel bone) and the bones of the leg (tibia and fibula).
The talus is crucial for ankle mobility and stability, and its blood supply is limited, increasing the risk of complications such as avascular necrosis.
Talus fractures often occur from high-energy trauma, such as falls from heights or car accidents, and cause severe pain, swelling, and inability to walk.
Diagnosis
Diagnosis is based on the history of significant trauma and physical examination, where acute pain, swelling, and sometimes deformity of the ankle are detected. X-rays confirm the fracture and assess its extent. CT scans are useful for identifying complex fractures, while MRI can help evaluate the risk of avascular necrosis.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Calcaneus fracture | Severe heel pain, usually from falls, with visible deformity on X-rays. |
Ankle dislocation | Visible displacement of the joint, often associated with talus or malleolar fractures. |
Malleolar fracture | Intense pain localised to the medial or lateral malleoli, confirmed by X-ray. |
Severe ankle sprain | Pain and instability without evidence of fracture on X-rays. |
Talus stress fracture | Progressive pain with physical activity, usually without displacement on initial X-ray. |
Emergency Management
Initial management of a talus fracture in the emergency department includes immediate immobilisation of the ankle with a posterior splint to prevent further displacement of bone fragments.
Elevation of the foot, ice application to reduce swelling, and administration of analgesics and NSAIDs for pain control are recommended. Neurovascular status must be assessed to rule out vascular or nerve damage.
In open fractures, antibiotics should be administered, and urgent surgical debridement is required. For displaced fractures, early referral to orthopaedics for surgical reduction is advised.
Definitive Treatment
Treatment of talus fractures depends on the type and severity of the fracture:
Non-displaced fractures:
Conservative treatment: Involves immobilising the ankle with a splint or orthopaedic boot for 6 to 8 weeks. Weight-bearing is prohibited during this period to avoid fragment displacement.
Displaced fractures:
Open reduction and internal fixation (ORIF): This is the preferred treatment for displaced fractures. Surgery realigns the bone fragments and stabilises them with screws or plates to promote proper healing and reduce the risk of complications like post-traumatic arthritis.
Fractures associated with avascular necrosis:
Avascular necrosis (loss of blood flow to the talus) is a serious complication, particularly in displaced fractures. Treatment may include decompression techniques or reconstructive procedures to restore joint function.
Rehabilitation
After treatment, whether conservative or surgical, rehabilitation is crucial to restore ankle mobility and strength. Weight-bearing should be reintroduced gradually under medical supervision. Physiotherapy includes range of motion, strengthening, and proprioception exercises.
Radiological follow-up is essential to monitor bone healing and detect complications such as avascular necrosis or arthritis. Although talus fractures are serious injuries, proper treatment and rehabilitation can lead to a good recovery, though some fractures may result in long-term complications such as joint stiffness or arthritis.
Comments