ABSTRACT
CONTENTS I. Introduction .................................................................................................................... 50 II. History............................................................................................................................. 50 III. Anatomy.......................................................................................................................... 51
A. The Head of the Talus ............................................................................................. 51
B. The Neck of the Talus.............................................................................................. 51
C. The Body of the Talus ............................................................................................. 52
D. Blood Supply ........................................................................................................... 52
1. Posterior Tibial Artery ...................................................................................... 54
2. Dorsalis Pedis Artery and Peroneal Artery ....................................................... 54
3. Intraosseous Circulation.................................................................................... 54 IV. Fractures of the Talar Neck ............................................................................................ 55
A. Clinical Features ...................................................................................................... 56
B. Classification............................................................................................................ 56
C. Imaging Studies........................................................................................................ 56
D. Categories ................................................................................................................ 58
1. Group I Fractures ............................................................................................. 58
2. Group II Fractures ............................................................................................ 59
3. Group III Fractures........................................................................................... 61 V. Surgical Techniques ......................................................................................................... 62 VI. Hawkins III Open Fractures............................................................................................ 65 VII. Hawkins Type IV Injuries ............................................................................................... 67 VIII. Total Dislocation of the Talus......................................................................................... 68 IX. Shear Fractures of the Talar Body .................................................................................. 70 X. Complications.................................................................................................................. 70
A. Skin Problems .......................................................................................................... 70
B. Osteomyelitis............................................................................................................ 71
C. Avascular Necrosis (AVN)....................................................................................... 75
D. Nonunion................................................................................................................. 75
E. Malunions of the Talar Neck................................................................................... 76
F. Posttraumatic Arthritis ............................................................................................ 76 XI. Surgical Treatment .......................................................................................................... 76
A. Principles of Arthrodesis.......................................................................................... 76
1. Ankle Arthrodesis ............................................................................................. 77
B. Tibiotalar Fusion with Partial Talectomy................................................................ 78
C. Talectomy and Tibiocalcaneal Fusion ..................................................................... 78 XII. Osteochondral Lesions (OCLS) of the Talus ................................................................... 79
A. Treatment................................................................................................................. 82
B. Prognosis.................................................................................................................. 84 XIII. Fractures of the Posterior Process ................................................................................... 84
A. Anatomy .................................................................................................................. 84
B. Mechanism of Injury................................................................................................ 84
C. Clinical Features ...................................................................................................... 85
D. Treatment................................................................................................................. 85 XIV. Fracture of the Medial Tubercle (Cedell’s Fracture) ....................................................... 85 XV. Fractures of the Lateral Process ...................................................................................... 87
A. Clinical Evaluation................................................................................................... 87
B. Mechanism of Injury................................................................................................ 87
C. Clinical Evaluation................................................................................................... 89
D. Treatment................................................................................................................. 89 XVI. Conclusion....................................................................................................................... 89 References ................................................................................................................................... 89
I. INTRODUCTION
Injuries to the talus account for only 1% of all fractures, but are among the most challenging to treat because of the bone’s unique anatomic characteristics. The talus has no muscle or tendon attachment and most of its surface is covered with articular cartilage, which leaves a limited area for blood supply in and out of the bone.
