Treatment for Talus Fracture
The treatment for talus fractures requires surgical fixation for displaced fractures to restore joint congruity and prevent long-term disability, while non-displaced fractures may be managed conservatively with immobilization. 1
Diagnostic Approach
- Initial evaluation should include standard radiographic studies (three-view ankle radiographs) to confirm the diagnosis and determine fracture pattern and displacement 1, 2
- CT scanning is essential for better visualization of fracture patterns, particularly for talar body/dome fractures and to determine exact extent, displacement, and any intra-articular extension 1, 2
- MRI may be indicated to assess associated soft tissue injuries, ligamentous damage, and bone marrow edema patterns 1, 2
Treatment Algorithm Based on Fracture Type
Non-displaced Fractures
- Simple immobilization is appropriate when fracture fragments are small, non-articular, or minimally displaced 1
- Close monitoring with follow-up imaging is necessary to ensure proper healing and detect any subsequent displacement 1
Displaced Fractures
- Surgical fixation is the primary recommendation for displaced fractures, especially those with articular involvement 2
- A fragment size of 15mm or larger warrants surgical fixation to restore joint congruity and prevent instability 2
- Open reduction and internal fixation (ORIF) is the preferred method to restore tibiotalar and subtalar joint congruency and prevent post-traumatic arthritis 3
- Dual incisions and a combination of minifragment plates and screws should be used for optimal fixation 4
Lateral Process Fractures
- Often missed on initial radiographs, requiring careful evaluation 4
- Conservative treatment should only be considered for non-displaced, small-fragment, and extra-articular fractures 5
- Surgical treatment is recommended for displaced lateral process fractures to achieve good long-term outcomes 5, 6
Post-operative Management
- Non-weight bearing for 6-8 weeks in a cast or fixed-ankle walker device following surgical fixation 2
- Appropriate pain management after surgical reduction 1
- Antibiotic prophylaxis for open fractures or following surgical intervention 1
- Progressive weight bearing and physical therapy after adequate healing is confirmed radiographically 2
- Rehabilitation program should include early post-fracture physical training and muscle strengthening 1
Complications and Pitfalls to Avoid
- Inadequate imaging may miss lateral process fractures or other associated injuries 1, 5
- Underestimating rehabilitation needs can lead to suboptimal functional recovery 1
- Overly aggressive rehabilitation before adequate healing can lead to fixation failure 2
- Common complications include osteonecrosis, malunion, post-traumatic arthritis, and infection 4
- Failure to recognize associated ligamentous injuries can compromise surgical outcomes 2
Prognostic Factors
- Articular incongruence after treatment correlates significantly with poorer functional outcomes 7
- Talus body fractures generally have worse outcomes than other fracture types 7
- Delayed surgery after trauma (allowing for soft tissue recovery) is associated with better outcomes than immediate surgery 7
- Post-operative CT is recommended to verify the quality of reduction, as restoration of articular congruence is critical for improving outcomes 7