What is the treatment for a talus fracture?

Treatment for Talus Fracture

The treatment for talus fractures requires surgical intervention with open reduction and internal fixation for most displaced fractures to restore joint congruency and prevent complications, while non-displaced fractures may be managed with immobilization. 1

Diagnostic Approach

• Initial evaluation should include radiographic studies to confirm the diagnosis and determine fracture pattern and displacement 2
• CT scanning is recommended for better visualization of fracture patterns that may be difficult to detect on plain radiographs, particularly for talar body/dome fractures and subtalar joint involvement 2
• MRI may be indicated for evaluation of associated soft tissue injuries and to assess for bone marrow edema patterns 2

Treatment Algorithm Based on Fracture Type

Displaced Talar Neck and Body Fractures

• Urgent surgical intervention is required to reduce risk of avascular necrosis 3
• Open reduction and internal fixation using dual incisions with a combination of minifragment plates and screws is the standard approach 1
• Percutaneous reduction and screw fixation may be considered in cases with compromised soft tissues or multiple injuries 3
• Anatomic reduction is critical to restore tibiotalar and subtalar joint congruency 4

Non-displaced Fractures

• Simple immobilization may be appropriate when fracture fragments are small, non-articular, or minimally displaced 2
• Close monitoring with follow-up imaging is necessary to ensure proper healing 2

Lateral Process Fractures

• These are frequently missed on initial radiographs and require careful evaluation 1
• Treatment depends on fragment size and displacement, with surgical fixation indicated for larger fragments 1

Post-operative Management

• Appropriate pain management after surgical reduction 2
• Antibiotic prophylaxis for open fractures or following surgical intervention 2
• Early mobilization with protected weight-bearing as determined by fracture pattern and fixation stability 2
• Rehabilitation program should include early post-fracture physical training and muscle strengthening 2

Complications and Their Management

• Avascular necrosis (AVN) is a significant concern, especially in displaced fractures, with rates varying from 15-50% depending on fracture pattern and displacement 5
• Post-traumatic arthritis of the ankle and subtalar joints is common (up to 61% for subtalar arthritis) 5
• Malunion and nonunion may require secondary procedures 1
• Secondary fusion procedures may be necessary for patients with significant post-traumatic arthritis or AVN 5

Special Considerations

• Prompt reduction of any associated dislocations is critical to preserve blood supply 1
• Patients should be taken to the operating room as soon as they are medically stable 1
• The quality of anatomic reduction directly correlates with functional outcomes 6, 5
• Even with optimal treatment, many patients may not return to pre-injury activity levels 5

Pitfalls to Avoid

• Delayed diagnosis and treatment increase the risk of avascular necrosis 3, 5
• Inadequate imaging may miss lateral process fractures or other associated injuries 2, 1
• Failure to achieve anatomic reduction significantly worsens outcomes 6
• Underestimating the rehabilitation needs following these injuries can lead to suboptimal functional recovery 2