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Fractures of the Talus



- Type I:
    - non displaced fracture of talar neck:
    - only those frxs in which there is no displacement of the subtalar joints should be designated as type I frxs;
    - type I frxs are treated w/ below the knee cast immobilization for 8-12 weeks until clinical & x-ray signs of fracture healing are present;
    - non-weight bearing for 4 to 6 weeks;
- Type II:
    - displaced frx of talar neck w/ subluxation of dislocation of subtalar joint (ankle remains aligned);
    - type II frxs include talar neck frx w/ any displacement (no matter how slight) or w/ concomitant subluxation or dislocation of the 
          posterior facet
    - persistent slight displacement will result in varus malunion;
    - even moderate displacement of the fracture fragements may cause tenting of the skin and the possibility of skin necrosis
            - prompt reduction of this fracture is critical to avoid skin slough;
    - ORIF:
         - once reduction is achieved & confirmed by x-ray, fixation can be achieved w/ 2 K wires driven across frx site parallel to axis of       
              talar neck combined w/ non-wt bearing plaster cast;
         - also consider fixation with an AO cancellous screw (6.5 mm)
- Type III fractures:
    - displaced frx of talar neck with dislocation of the body of talus from both subtalar and ankle joint;
    - body fragment is usually wedged posteiorly & medially, so that it is rotated around intact deep fibers of deltoid ligament to lie in soft 
          tissues w/ frx surface point laterally and cephalad;
    - 25% are open frx;
    - closed fractures will cause overlying skin necrosis;
    - ORIF
        - deep fibers of deltoid ligament usually remain attached to talar body;
              - these fibers should not be released as they may carry only remaining arterial supply to the body;
        - to gain exposure, it is more logical to osteotomize medial malleolus & reflect it distally to ease reduction rather than cutting intact deltoid;
        - once reduction is achieved, internal fixation consists of 2 K wires or compression screws placed perpendicular to frx line