PAPER

TALUS FRACTURE
SUPERVISOR :

dr. OK Ilham A. Irsyam, Sp.OT(K)

John Siow Hee Ginn 150100127

Filza Aldina Humaira 140100176
Shobana Sandrasakre 150100195
Asuvini Selvam 150100199
Devi Narayani Manoharan 150100208
Febrina Setiawan 120100229
M. Ariadi S. Dalimunthe 140100144
 CHAPTER 1

Introduction
 In everyday life, trauma on the part we often
encounter. One of the most important injuries
to the foot we know is the thallus fracture.
Talus fractures are uncommon, but they can
be found due to injuries such as hard impact
due to a car accident or falling from a height.

 This talus fracture must be handled

appropriately because of the high rate of
osteonecrosis in this area and avascular
necrosis which occurs in almost 50% of all
fractures with dislocation of the talus neck
resulting in failure to link
 CHAPTER 2

LITERATURE
REVIEW
 ANATOMY
 Talus bone is irregularly shaped bone.
This bone articulates with the medial
tibia maleolus and with the lateral
maleolus fibula to form the ankle joint.
 The front part is related to naviculare
bone and the lower part is related to os
calcaneus bone.
 Talus has
 Head
 Neck
 Body
 Lateral process
 Posterior process
 Talus fracture
 A fracture is a break in the continuity of bone tissue
and / or cartilage which is generally caused by
involuntary.
 Talus fracture namely the presence of involuntary
forces that cause the os talus to experience bone
tissue discontinuity .
 The incidence rate of talus fracture represents 3% of
all leg fractures and 50% is in the neck of the talus,
and fractures on the body of the talus and other parts
are rarely only around 7-8% of all talus fractures.
 Classifications of talus
fracture
 Fracture of the talus neck
 Sometimes there are often subtalar dislocations. The most
common cause of fractures in the neck of the talus is strong
leg pull when applying brakes suddenly during a motor
vehicle accident or falling from a height.
 Lateral process fracture (snowboarder’s fracture or
snowboarder’s ankle)
 Caused by a snowboarding accident where the foot
experiences dorsiflexion and inverted. These fractures are
often confused with ankle sprain
 Posterior process fracture (shepherd’s fracture)
 Because the foot suddenly experiences an extension so that
the front foot is depressed lower than the heel (plantar flexion)
like a driver who has an accident with the foot stepping on the
pedal or in repetitive movements (athletes and dancers) so that
the talus corpus is dislocated towards posterior.
 Talar dome fractures
 Most often due to the presence of small cartilagenous
avulsions or talar fragments in the tibial articulation site and
most often associated with ankle inversion injuries.
 Clinical Manifestations
 Acute pain
 Inability to support body weight
 Legs have clear deformity
 Skin can experience necrosis quickly
 Swelling and tenderness
 Diagnosis Talus Fracture
 Physical examination
 A patient with a tarsal fracture is most often seen
on the skin so quickly experiencing necrosis that
the dorsalis pedis artery must be palpated to check
for signs of vascularity and can also see swelling,
deformity and severe pain.
 Supporting investigation
 The usual standard examination is an x-ray
examination, but if the x-ray examination does not
show a clear fracture, Computer Tomography can
be done
 On x-ray examination, anteroposterior, lateral and oblique
photographs are required. First the talus is recognized (not
always easily) then examined to see if this is a fracture or
dislocation or both and compared to a normal leg.

 Fractures usually cross the neck of the talus and fragments

can shift a lot. If so, there must be an inevitable subluxation of
the talocalcaneus joint. Sometimes the posterior fragment
actually dislocates from the ankle mortise.

 Fractures on the head or body of the talus or in the processus

are rare, but care must be taken where there are occasionally
debris which appear to be unimportant beneath the lateral
maleolus but in the oblique position 20 degrees turns out to be
an important fragment that is the lateral processus of the talus
which is fractured
 Management
1. Talus fracture that does not shift
 If the shift is only mild, reduction is not necessary
 Below knee cast with plantigrade position for 8 weeks

2. Shift and fracture-dislocation fractures

 If the fracture is closed, reposition is closed and the use of
blow knee cast plantar flexion 2-3 weeks ago replaced with a
blow knee cast platigrade ± 6 weeks
 If the fracture is open - do debridement
3. Operative
 if closed repositioning does not work
 in open fracture
 done by installing k. wire or lag screw and must be
as atomic as possible / absolutely right

4. If the cast has been removed, the patient is

recommended to train the legs and feet but he must
avoid holding the body load until the x-ray
examination shows that the talus does not
experience avascular necrosis
Closed reduction technique and
traction
Open reduction
 Lateral side

Medial

Fixation with k-
wire and screw
 Complications
 Early:
 skin damage
 Often found because the skin is torn or because
it is stretched so strongly that it experiences
necrosis.
 Stretched skin must be treated immediately by
reducing the fracture or blocking it.
 Open injuries and necrosis must be treated with
careful debridement to reduce the risk of infection
• Discharge of talus
 In open injuries, sometimes the talus is detached and located
within the wound, after adequate debridement and cleaning, the
talus it must be put back on mortise and stabilized, if necessary
the Kirschner wire which is bound across.
 - Malunion

- Appropriate reduction needs to be emphasized

- Malunion can cause distortion on the joint surface, limited mobility
and pain when holding weights
 Avascular necrosis
- Avascular necrosis of the body of the talus or the entire talus
region occurs in more than 50% of shifts in the talus neck fracture.
- X-ray signs show a marked increase in density in the avascular
segment.
- Despite necrosis, the fracture can heal, so therapy should not be
stopped in this event.
But if the talus becomes flat or cut or if pain and malfunction are
apparent, the ankle may need to be artrodesized.
 Secondary osteoarthritis
- Can occur several years after injury
- There are several causes such as
articular damage due to initial injury,
malunion and distortion of the joint surface
and avascular necrosis of the talus
 Conclusion
 Talus fracture is the presence of involuntary labor that causes os
talus to experience bone tissue discontinuity.
 Talus fractures consist of 4 types, namely fractures of the neck,
body, lateral and posterior processes that depend on the trauma
mechanism.
 Clinical manifestations of talus fractures, namely acute pain,
deformity, swelling, tenderness, and skin can experience necrosis.
 To diagnose this fracture, it can be done through history taking to
find out the mechanism of trauma and physical examination as well
as from supporting examinations namely x-rays and CT scans.
 On x-ray examination, examination with anteroposterior, lateral and
obliq positions is very necessary and compare with normal
photographs.