What is the treatment for a dorsal talus fracture?

Treatment of Dorsal Talus Fractures

The optimal treatment for dorsal talus fractures requires CT imaging for accurate assessment of fracture characteristics, followed by open reduction and internal fixation for displaced fractures to restore joint congruity and prevent post-traumatic arthritis. 1, 2

Diagnostic Approach

• Initial evaluation should include standard ankle radiographs, but these may miss subtle fractures or underestimate the extent of injury 3
• CT is the first-line imaging study after radiographs to determine extent, displacement, comminution, intra-articular extension, and associated injuries 3
• MRI is valuable for assessing associated bone marrow contusions, osteochondral injuries, and soft tissue damage, especially important for talus fractures which are at higher risk for osteonecrosis 3
• The Broden view (supine flexed knee view with 30-45° internal rotation) can be helpful for evaluating lateral process fractures of the talus 3

Treatment Algorithm

For Non-displaced or Minimally Displaced Fractures

• Simple immobilization is appropriate when fracture fragments are small, non-articular, or minimally displaced 3
• Protected weight-bearing with immobilization in a cast or fixed-ankle walker-type device 3
• Radiographic follow-up at approximately 3 weeks to confirm adequate healing 4

For Displaced Fractures

• Open reduction and internal fixation (ORIF) is the mainstay of treatment for displaced talar fractures 2
• Prompt surgical intervention is recommended as soon as the patient is medically stabilized 2
• Surgical approach:
  • Dual incisions may be required for adequate exposure 2
  • Combination of minifragment plates and screws should be used for optimal fixation 2, 5
  • For multifragmentary fragments, plate fixation is preferred over isolated screw fixation 5

For Specific Fracture Types

• Lateral process fractures:
  • Small, non-displaced fragments can be treated conservatively 6
  • Larger displaced fragments require ORIF with screws or plate fixation 6, 5
• Medial tubercle avulsion fractures:
  • Acute diagnosis and appropriate immobilization with limited weight-bearing yields excellent results 7
  • Missed fractures may require delayed operative excision for persistent pain 7

Post-operative Management

• Active finger motion exercises should be initiated as soon as stability allows to prevent stiffness 8
• Protected weight-bearing until radiographic evidence of healing 4
• Regular radiographic follow-up to monitor for complications 4

Potential Complications

• Osteonecrosis is a significant risk due to the tenuous blood supply of the talus 2
• Post-traumatic arthritis of the ankle and subtalar joints is common, especially with intra-articular extension 2
• Malunion and nonunion may occur, particularly with inadequate reduction or fixation 2
• Joint stiffness is a common functional disability that can be minimized with appropriate early motion 8

Special Considerations

• High-energy trauma mechanisms typically cause these fractures, requiring thorough evaluation for associated injuries 1
• The majority of the talus is covered by articular cartilage, making anatomic reduction crucial for functional outcomes 1
• Treatment should be customized based on fracture morphology, with the goal of restoring tibiotalar and subtalar joint congruency 1