- 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