Talus Fractures

Talus fractures and fracture-dislocations are rare conditions that are associated with high risk of complications and long-term disability. Its meticulous anatomy and intricate vascularization need to be considered when planning a proper treatment in order to prevent or deal with possible complications. Talus fractures represent 0.1–2.5% of all fractures in general and 3% in the foot. The most commonly used classification system was originally described by Hawkins consisting of three types, based on the blood supply damage and the radiographic pattern. Standard imaging protocol for talus fractures includes a routine foot series (AP, lateral, and oblique) and ankle series (including AP and mortise) in addition to a CT scan of the foot. Non-operative treatment is reserved for confirmed nondisplaced Hawkins type I fractures. Biomechanical studies have demonstrated that a minimum displacement of 2 mm significantly alters subtalar congruency, which may predispose to osteoarthritis. Current standard of care for displaced talar neck and body fractures is open reduction and internal fixation. Subtalar joint arthritis is the most common complication after a talar neck or body fracture, and the one that leads to reconstructive surgeries such as arthrodesis and osteotomies. The incidence of avascular necrosis after talar neck fracture is proportional to the initial fracture displacement. A non-anatomic fracture reduction or fixation may lead to a hindfoot malalignment. Slight displacement of talar neck fractures may produce symptomatic varus malunion in almost 50% of these fractures secondary to comminution of the medial aspect of the neck.