Treatment of Non-Displaced Fracture at the Lateral Margin of the Taylor Dome
Non-displaced fractures of the lateral talar dome should be treated with rigid immobilization in a non-weight bearing cast for 6 weeks, followed by a supervised functional rehabilitation program. 1
Initial Management
- Non-displaced talar dome fractures require rigid immobilization rather than removable splints to ensure proper healing and prevent displacement 2
- Cast immobilization is the preferred treatment method for minimally displaced fractures of the talar dome, similar to other non-displaced fractures 2
- The patient should be kept non-weight bearing for 6 weeks to allow proper healing of the fracture 1
- During immobilization, active range of motion exercises should be encouraged to maintain joint mobility 1
Imaging Considerations
- Initial radiographs may not fully characterize the extent of the fracture, and CT without IV contrast may be beneficial to evaluate the fracture pattern and guide treatment decisions 2
- MRI without contrast is an alternative imaging option if there is concern for associated ligamentous or soft tissue injuries 2
- Follow-up radiographs should be obtained at 3 weeks and at the cessation of immobilization to monitor healing 2
Rehabilitation Protocol
- After 6 weeks of non-weight bearing immobilization, the patient should begin a supervised functional rehabilitation program 1
- Rehabilitation should include early introduction of physical training and muscle strengthening, followed by long-term balance training 2
- Gradual return to weight-bearing activities should be initiated after confirmation of adequate healing on follow-up imaging 1
Special Considerations
- If the fracture shows signs of displacement during follow-up, surgical intervention may be necessary 1, 3
- Surgical options include excision of the fracture fragment with curettement and drilling of the fracture bed, or open reduction and internal fixation depending on fragment size and location 1, 3
- Persistent pain after 6 weeks of conservative management may indicate inadequate healing and should prompt consideration of surgical intervention 1, 4
Potential Complications
- Talar dome fractures are often initially misdiagnosed as ankle sprains, leading to delayed treatment and potential complications 1, 4
- Inadequate treatment may result in persistent pain, decreased range of motion, or post-traumatic arthritis 1
- Careful monitoring during the healing process is essential to identify any loss of reduction that might require surgical intervention 2, 1
Long-term Follow-up
- Patients should be educated about the nature of their injury, the importance of compliance with treatment, and the potential for subsequent fractures 2, 5
- Follow-up imaging at 3 months is recommended to confirm complete healing before return to full activities 2
- In patients over 50 years of age, evaluation for osteoporosis and risk of subsequent fractures should be considered 5