Talar Fracture Flashcards
What is the MOI of talar fractures
High energy trauma in which the ankle is dorsiflexed and the tibial plafond hits the talus causing a fracture
Where do most talus fractures occur
Talar neck
What is the blood supply to the talus and why is the talus susceptible to avascular necrosis
Supplied by the extraosseous arterial supply which is susceptible to interruption
what are the clinical features of talar fractures
Immediate pain
Swelling
Deformity if dislocated
Unable to dorsifelx/ plantarflex
What are the differential diagnosis for talar fractures
Ankle fracture
Pilon fracture
What are the investigations that are required
Xrays - AP and lateral
Lateral should be taken in dorsi and plantar flexion
Complex fractures at require CT
How are talar neck fractures classified
Hawkins classification - helps to aid management and risk of avascular necrosis
What is a type 1 Hawkins fracture
Undisplaced
AVN risk = 0-15%
What is Hawkins type 2
Subtalar dislocation
AVN risk = 20-50%
What is Hawkins type 3
Subtalar and tibiotalar dislocation
AVN risk = 90-100%
What is Hawkins type 4
Subtalar, tibiotalar and talonavicular dislocation
AVN Risk - 100%
What is the management of type 1 fractures
conservatively in a plaster with non-weight bearing crutches for approximately 3 months. Following this, the region should be assessed for evidence of union and avascular necrosis in fracture clinic.
What is the treatment for type 2 till 4 fractures
Closed reduction first
Cast
Repeat radiographs
If reduction not possible then open reduction needed and definitive surgical fixation to be booked in the next available list
what are the complications of talar fractures
AVN
OA
