TALUS

FRACTURES

Dr. Anshu Sharma

Assistant Prof.
Dept. of Orthopaediscs, GMC&H
Introduction

 The heel bone of horse was used as dice and was

called Taxillus. This Word evolved into Talus
 In 1919, Anderson published a series of foot injuries
sustained by aviators in World War I which he called
Aviator's Astralagus.
 In 1970, Hawkins developed a classification of talus
fractures, which provided guidelines for treatment as
well as the prognosis of different fracture types
 Later on, Canale and Kelly Expanded the HAWKINS
classification system and introduced type 4 .
OSSEOUS ANATOMY OF
TALUS
 Talus is one of the 7 tarsal bones of the foot.
 It acts as a connecting link between the Foot
and the Leg
 It is unique as 60% of it’s surface is articular,
which articulates with Tibial plafound, Medial
malleolus, Lateral malleolus, Calcaneum, and
Navicular bones.
 It has Ligamentous and Capsular attachments,
but no muscular attachments
 Parts

Talus has
A. Head
B. Neck
C. Body
D. Lateral Process
E. Posterior Process
 Head

Head is intra-articular
• Anteriorly : NAVICULAR bone
• Inferiorly : Sustentaculum Tali of
Calcaneum

Head is supported inferiorly by Plantar

Calcaneo-navicular or Spring ligament
All three together form Talo-Calcaneo-
Navicular joint
Neck

 NECK is non-articular
 Directed forward , medial word ,
downward
 It forms 15˚ angulation medially with
the body
 Medial - Sinus Tali corresponds with
Sinus Calcani to form TARSAL
CANAL
 Lateral - tarsal canal opens into
funnel shaped TARSAL SINUS
  .

.
Body
BODY :
• Superior surface
• Inferior surface
• Lateral surface
• Medial surface
• Posterior surface
Lateral process

LATERAL PROCESS :
• Wedge shaped
• Superiorly and Laterally - Lateral
malleolus
• Inferiorly and Medially -
Calcaneum
 Posterior process
POSTERIOR PROCESS :
• It has Medial and Lateral tubercle
• FHL passes in between.
• Lateral : Anterior, Lateral, and Posterior Talofibular
Ligament
• Medial : Deltoid ligament
• OS TRIGONUM - seen in 50% people, develops
from separate ossification centre posterior to Lateral
tubercle.
VASCULAR ANATOMY OF
TALUS
 Talus -60% of it’s surface is articular
 It receives blood supply through Capsular and Ligamentous attachments, and
Nutrient foramen in the Neck

 Talus is supplied by
A. Anterior Tibial artery
- Dorsalis Pedis artery
B. Posterior Tibial artery
- Posterior tubercle artery
- Artery of Tarsal Canal
- Deltoid artery
C. Peroneal artery
- Artery of Tarsal Sinus
 Anterior tibial
artery (16.2%)

Posterior tibial artery

Perforating artery(16.9)
(47%)
>Head and Neck - by DPA
>Body
- Medial 1/3 - Deltoid lig
- Middle 1/3 - Artery of Tarsal Canal
- Lateral 1/3 - Artery of Tarsal Sinus
>Posterior tubercle
- Branches from Posterior Tibial artery
 Crucial Anastomotic Sling is
formed in the Tarsal canal b/n
Artery of Tarsal canal and Artery
of Tarsal Sinus
 It gives branches to the Body of
Talus from Distal to Proximal
 In # Neck of Talus, this is
disrupted leading to
Osteonecrosis of Body of Talus
TALAR FRACTURES

 2nd most common tarsal # after Calcaneal

#
CLINICAL
EXAMINATION
 Patients presents with h/o trauma
 Followed by c/o Pain and swelling of the
hind foot
 Restriction of movements of the ankle
 O/E : Tenderness over Talus and Subtalar
joint
: Restriction of Ankle and Subtalar
movements
 RADIOLOGICAL
EXAMINATION
 X- RAYS
1. AP VIEW
2. LAT VIEW
3. CANALE VIEW
- For better visualization of neck
of Talus
A view of the talar neck achieved by
placing the foot plantigrade on the x
ray film and angling the beam at
75degrees top the perpendicular.
 CT SCAN - required to detect the fracture pattern
 MRI SCAN - may be done to identify the soft tissue
injury
CLASSIFICATION

 TALAR HEAD FRACTURES

 TALAR NECK FRACTURES
 TALAR BODY FRACTURES
 LATERAL PROCESS FRACTURES
 POSTERIOR PROCESS FRACTURES
 TALAR HEAD
FRACTURES
 MECHANISM OF INJURY:
• Fall from height, with Foot in plantar
flexion and compression force along
the long axis of the forefoot
Talo-Calcaneo-Navicular joint
disruption
Shortening of the medial column
Loss of the Medial longitudinal arch
TREATMENT
TALAR NECK
FRACTURES
 Most common type of Talar
Fractures
 It is so called, if # inferior line
is distal to Lateral process of
Talus
 AVIATORS ASTRAGALUS :
Pilots resting the sole of
the foot on the rudder bar in
crashing plane at the point of
impact causes
Hyperdorsiflexion of ankle
causing Talar neck #
MECHANISM OF
INJURY
With Hyperdorsiflexion, Posterior capsular ligament of Subtalar jt
rupture and Neck of Talus impacts against Anterior edge of Tibia,
leading to TALAR NECK #
With continuation of dorsiflexion force, Calcaneus with rest of foot
sub luxate forward, leading to Subtalar Subluxation
With continuation of dorsiflexion force, Posterior capsular ligaments
of ankle jt, Posterior Talo-fibular lig, and Deltoid lig rupture
Body of Talus is the wedged Postero-medially out of Tibial mortise,
b/n Medial malleolus and Tendo-achilles, leading to Subluxation of
ankle jt
With further dorsiflexion, Talo-navicular jt subluxation occurs
 HAWKIN’S
CLASSIFICATION
 Type I : Nondisplaced
AVN
 Type II : Displaced with Subtalar
Subluxation TYPE I 0-25%

 Type III : Assoc with Subtalar and Ankle

TYPE II 25-50%
subluxation
 Type IV : Assoc with Subtalar, Ankle and TYPE III 50-75%
Talo-Navicular subluxation
TYPE IV 75-100%
TREATMENT
SURGICAL APPROACH
Type II, III, IV are difficult to obtain anatomical reduction by closed reduction
TALAR BODY
FRACTURES
 It is so called, if # line is proximal to Lateral
process of Talus
 Incidence of AVN is same in Neck and
Body #, but Post-traumatic arthritis is more
with Body #.
MECHANISM OF
INJURY
 Axial compression of Talus between Tibial
Plafound and Calcaneum.
 Occurs due to fall from height or Motor
vehicular accidents
CLASSIFICATIO
N
TREATMENT
 BLAIR TIBIO-TALAR SLIDING GRAFT
CALCANEOTIBIAL FUSION
ARTHRODESIS

Antero-lateral incision Antero-lateral incision

Talectomy done Comminuted # fragments are removed

Posterior Displacement of navicular to Sliding graft from anterior surface Tibia

come in contact with Tibia used to fill the gap

Painless and stable No Posterior displacement of navicular

Decrease in Height and length of foot Foot is not shortened

Ankle and Subtalar jt are lost Subtalar and Talo-navicular jt are intact

Compensatory Midtarsal movements are Subtalar and Midtarsal movements are

present present
 LATERAL PROCESS OF
TALUS #
 Lateral process # occurs on
EVERSION OF DORSIFLEXED AND
AXIALLY LOADED FOOT
 Seen in Snowboarding injuries
 Lateral process has attachments to
Anterior, Lateral and Posterior Talo-
fibular ligaments
 V-sign for Radiographic diagnosis
V- sign
TREATMENT
 POSTERIOR PROCESS
OF TALUS #
 Posterior process of Talus has
Medial and Lateral tubercles
with FHL passing in the groove
 Medial tubercle - Deltoid Lig
 Lateral tubercle - Posterior
Talofibular lig
MECHANISM OF
INJURY
 Medial tubercle of Posterior
process # - Forceful eversion of
the ankle
 Lateral tubercle of Posterior
process # - Forceful inversion of
the ankle
TREATMENT

 Undisplaced - Conservative
 Displaced - ORIF with Herbert screw
fixation
COMPLICATIONS OF
NECK OF TALUS #

.
1. OSTEONECROSIS of Body of Talus :
in # neck of Talus, Due to loss of blood supply
- TALECTOMY + TIBIOCALCANEAL FUSION
- BLAIR TIBIO-TALAR SLIDING GRAFT ARTHRODESIS

2. Post-traumatic Arthritis
3. Malunion of Neck of Talus
- CORRECTIVE OSTEOTOMY OF NECK
4. Skin necrosis
 HAWKIN’S SIGN

Osteonecrosis is identified based on AP

radiograph between 6 and 8 weeks.

Subchondral lucency is indicative of

relative osteopenia secondary to bony
resorption and an intact blood supply.

Progresses from medial to lateral due to

vascular re-establishing from medial side
of dome through deltoid ligament.

Indicative of diffuse osteopenia with

vascular congestion suggests continuity of
blood supply
Thank you !!