anterior talar head to keep some of the height).
Talar Body Fractures
– most are high energy injuries with significant displacement
– best to try to treat with ORIF if the fragments are large enough to accept fixation
– approach through a medial malleolar osteotomy to preserve as much blood supply as possible
Talar Head Fractures
– if possible, treat like any other articular fracture with ORIF to preserve the talonavicular joint
– if talonavicular arthritis occurs, may be treated with arthrodesis
Lateral Talar Process Fracture
– Hawkins I – nonarticular chip fracture
– Hawkins II – single large fragment that involves both the talofibular and subtalar articulations.
– Hawkins III – comminuted fracture involving both articulations
Treatment – depends on displacement and size of fragment
– for large pieces, cast immobilization if nondisplaced, or ORIF.
– for comminuted pieces, primary excision
Posterior Process Fractures
– the tubercles are separated by the tendon of FHL
– lateral tubercle is the larger of the two, and projects more posteriorly.
– Fracture of the lateral tubercle of the posterior process:
– avulsion or compression between the calcaneus and posterior lip of tibia
– if small and undisplaced or minimally so, cast for 4-6 weeks
– if big, can try to fix
– if united, excision
– Fracture of the medial tubercle of the posterior process
– visualization is difficult – the lateral tubercle is what you see in profile on the lateral xray
– treat by ORIF or excision
– either medial or lateral (medial is more common)
– In the medial dislocation, the talus rides dorsolateral, while the calcaneus and the rest of the foot moves medially – 85%. This is caused by an inversion strain, tearing the weak talonavicular and talocalcaneal ligaments.
– In the lateral dislocation, the talus rides medially, while the calcaneus and foot go laterally – 15%
This is caused by an eversion strain.
– the medial dislocations are seen often in basketball players
Closed reduction, keeping the knee flexed to relax the Achillles tendon, then reversal of the deformity
Failure to get it closed is often due to soft tissue interposition (capsule, ligaments, ext digit brevis, tib post) or impaction fracture. With lateral dislocations tib post tendon is the most common obstruction.
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