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Fractures of the Talar Head

  • James Richman
  • Adam Gitlin
  • Mark R. AdamsEmail author
Chapter
  • 41 Downloads

Abstract

Fractures of the talar head are the most uncommon subset of talus fractures. Although rare, these injuries have the potential to cause substantial disability through alteration of the mechanics of the talonavicular joint, which can lead to chronic pain and abnormal gait. The mechanism of injury is either a compressive force of the midfoot against the talar head in a plantarflexed position or a shear force of the navicular against the medial talar head with the foot in an inverted position. Patients generally present with midfoot pain and an inability to bear weight. Radiographic evaluation of the talar head should include a Canale view for better visualization of the talar head and neck. CT scan is mandatory for surgical planning to determine the appropriate surgical approach and fixation strategy. Nondisplaced fractures can be managed nonoperatively in a cast. Indications for operative treatment include displacement, articular incongruity of the talonavicular joint, or instability of the talonavicular joint. Currently, there are no high-quality outcome studies to guide management of talar head fractures. The main complication of these injuries is talonavicular arthritis from a missed injury. An illustrative operative case example is presented at the end of the chapter to provide useful surgical techniques to treat these fractures. Overall, talar head fractures are significant articular injuries that should be treated aggressively to preserve the talonavicular joint with the goal of giving the patient the best chance to achieve a normal gait.

Keywords

Talus Talar head Talonavicular joint 

References

  1. 1.
    Pennal GF. Fractures of the talus. Clin Orthop Relat Res. 1963;30:53–63.CrossRefGoogle Scholar
  2. 2.
    Sangeorzan BJ, editor. Traumatized foot. Rosemont: American Academy of Orthopaedic Surgeons; 2001.Google Scholar
  3. 3.
    Ebraheim N, Sabry F, Nadim Y. Internal architecture of the talus: implication for Talar fracture. Foot Ankle Int. 1999;20:794–6.CrossRefGoogle Scholar
  4. 4.
    Mulfinger GL, Trueta J. The blood supply of the talus. JBJS Am. 1970;53B:160–7.Google Scholar
  5. 5.
    Higgins T, Baumgaertner M. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. Foot and Ankle Int. 1999;20(9):595–605.CrossRefGoogle Scholar
  6. 6.
    Sanders R, et al. Fractures and fracture-dislocations of the talus. Mann’s surgery of the foot and ankle. 9th ed. Philadelphia: Elsevier; 2014.Google Scholar
  7. 7.
    Richter M, et al. Foot injuries. Skeletal trauma: basic science, management and reconstruction. 5th ed. Philadelphia: WB Saunders; 2015.Google Scholar
  8. 8.
    Coltart WD. Aviator’s astralagus. JBJS Br. 1952;34(4):545–66.PubMedGoogle Scholar
  9. 9.
    Adelaar RS. The treatment of complex fractures of the talus. Orthop Clin North Am. 1989;20(4):691–707.PubMedGoogle Scholar
  10. 10.
    Canale ST, Kelly FB. Fractures of the neck of the talus: long term evaluation of seventy-one cases. JBJS Am. 1978;60(2):143–56.CrossRefGoogle Scholar
  11. 11.
    Kenwright J, Taylor RG. Major injuries of the talus. JBJS Br. 1970;52(1):36–48.PubMedGoogle Scholar
  12. 12.
    Early JS. Management of Fractures of the talus: body and head regions. Foot Ankle Clin N Am. 2004;9:709–22.CrossRefGoogle Scholar
  13. 13.
    Vallier H. Fractures of the talus: state of the art. J Orthop Trauma. 2015;29(9):385–92.CrossRefGoogle Scholar
  14. 14.
    Hansen ST. Functional reconstruction of the foot and ankle. Philadelphia: Lippincott, Williams and Wilkins; 2000.Google Scholar
  15. 15.
    Lamothe JM, Buckley RE. Talus fractures: a current concepts review of diagnoses, treatments, and outcomes. Acta Chir Orthop Traumatol Cechoslov. 2012;79(2):97–106.Google Scholar
  16. 16.
    Schulze W, et al. Surgical treatment of talus fractures: a retrospective study of 80 cases followed for 1–15 years. Acta Orthop Scand. 2002;73(3):344–51.CrossRefGoogle Scholar
  17. 17.
    Ibrahim MS, et al. Talar head fracture: a case report, systematic review and suggested algorithm for treatment. Foot. 2015;25:258–64.CrossRefGoogle Scholar
  18. 18.
    Long NM, et al. Insufficiency and nondisplaced fractures of the talar head: MRI appearances. Am J Roentgenol. 2012;1999:613–7.CrossRefGoogle Scholar
  19. 19.
    Sarrafian S. Anatomy of the foot and ankle. Philadelphia: Lippincott; 1983.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.MultiCare Orthopedics & Sports MedicineTacomaUSA
  2. 2.Crystal Run Healthcare, MiddletownUSA
  3. 3.Associate Professor, Department of Orthopedics, Trauma DivisionRutgers – New Jersey Medical SchoolNewarkUSA

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