Talus anatomy and body fractures

Question 1

How much is the talus covered in articular cartilage ?

Answer 1

GREATER THAN HALF

Question 2

Does the talus have any muscle or ligament attachments?

Answer 2

No

Question 3

Name the 3 main blood supply to the talus?

Answer 3

POSTERIOR TIBIAL ARTERY
DORSALIS PEDIS ARTERY
PERFORATING PERONEAL ARTERY

Question 4

What supplies the TALAR BODY?

Answer 4

ARTERY OF TARSAL CANAL from POST. TIBIAL ARTERY

DELTOID ARTERY also comes off post tiibial

Question 5

What supplies the Talar Head and Neck?

Answer 5

DORSALIS PEDIS

ARTERY OF TARSAL SINUS- from the PERFORATING PERONEAL ARTERY

Question 6

What landmark determines a talar body fracture?

Answer 6

POSTERIOR to the LATERAL PROCESS

Question 7

What joints does a talar body fracture involve ?

Answer 7

SUBTALAR

TIBIOTALAR

Question 8

Describes the types of talar body fractures?

Answer 8

LATERAL PROCESS
POSTERIOR PROCESS
TALAR HEAD
TALAR BODY

Question 9

What xrays views are helpful in identification of the fracture?

Answer 9

AP and LATERAL

CANALe view- MAX EQUNIUS, 15 DEGREES PRONATED, XRAYS 75 DEGREES CEPHALD OFF HORIZONTAL

Question 10

What is the tx of undisplaced talar body fractures ? What is the criteria of undisplacement?

Answer 10

SLC 6 weeks

less than 2mm displaced

Question 11

What is the TX of displaced talar body fractures? What is the criteria of displacement?

Answer 11

Surgery- ORIF/ K wires
if displacement >2mm
Can excise comminuted peices of post process/ lat process

Question 12

What approaches would be made for a lat process fracture orif?

Answer 12

LATERAL

Question 13

What approaches would be made for a post process fracture orif?

Answer 13

POSTERIOLATERAL

Question 14

What approaches would be made for a talar body fracture orif?

Answer 14

dual incision MEDIAL AND LATERAL

Question 15

What are the complication of the fracture?

Answer 15

AVN - diagnosed by SCLEROSIS ON XRAY

TALONAVICULAR ARTHRITIS

Question 16

What is HAWKING’S sign? When is it best seen?

Answer 16

SUBCHONDRAL LINEAR LUCENCY OF TALAR DOME on xray. A sign of REVASCULARISATION
6-8 weeks post injury

Question 17

What is the most common talus fracture?

Answer 17

Talar neck fractures

Question 18

What is the mechanism of talar neck fractures?

Answer 18

FORCED DORSIFLEXION ADN AXIAL LOAD

Question 19

What is the talar neck classification?

Answer 19

HAWKINS CLASSIFICATION- on joint dislocation and risk of AVN

Question 20

What is a HAWKINs type I and its risk of avn?

Answer 20

A NONIDSPLACED FRACTURE

AVN RISK 0-13%

Question 21

How do you tx hawkins type 1?

Answer 21

A short leg cast NWB 6-8 weeks

Regular xrays to confirm position

Question 22

What is a HAWKINs type 2 and its risk of Avn?

Answer 22

Displacement of talar fracture and ST dislocation/subluxation
AVN risk 30-45%

Question 23

How do you tx hawkins 2?

Answer 23

Closed reduction- plantarfelxion foot and heel manipulation then slc nwb 6-8 wks
ORIF is displaced. nwb 10-12 weeks post surgery

Question 24

What is a HAWKINs type 3 and its risk of Avn?

Answer 24

Displacement of talar neck fracture with Subtalar and tibiotalar joint dislocations
AVN 90-100%

Question 25

How do you tx hawkins 3?

Answer 25

ORIF- 2 incisions
anteromedial - between tibilalis ant and post tibialis - preserve soft tissue including deltoid as has deloid artery to talar body in it
anterolateral between tibia and filbular prox and inline with 4th ray- elevate EDB
anatomical reduction of fragments
NWB cast post op 10-12 weeks

Question 26

What is a HAWKINs type 4 and its risk of Avn?

Answer 26

Displacement of talar neck fracture with subtalar, tibiotalar and talonavicular joint dislocation
AVN risk 90-100%

Question 27

How do you tx hawkins 4?

Answer 27

Urgent ORIF 2 incisions, aim for anatomical reduction. NBW 10-12 weeks

Question 28

What are the complications of talar neck fractures?

Answer 28

AVN
POST TRAUMATIC ARTHRITIS- SUBTALAR 50%
VARUS MALUNION- 25-30%
NON UNION (TYPE 3-4) 13%