Surgical Anatomy of Talus

DR KSHITIZ SAPKOTA
FIRST YEAR RESIDENT
ORTHOPEDICS AND TRAUMA SURGERY
NAMS
 ANATOMY

Articulates above at Ankle joint with Tibia/Fibula,

below with Calcaneum and infront with Navicular bone.
Snail shaped bone when viewed from medial or lateral
sides
Second largest tarsal bone.

Ossification – from one centre which appear in 6th

month of intrauterine life

60 surface % is covered with articular cartilage

Parts: Head, Neck, Body
 Head

The Talar head has

Anteriorly: articular
facets for the
Navicular
Inferiorly: Spring
ligament(plantar
calcaneonavicular lig.)
Postero-inferiorly :
Sustentaculum tali and
Medially: Deltoid
ligament
 Neck…
 Constricted portion of bone between
the body and the head
 Directed forward , medial and
downward
 Angle of medial deviation is 15 to 20
degree in adults
 Plantar deviation is 24 degree
approx
 Neck body angle is 150 degree in
adults
 Relatively thin diameter makes it
weaker area and hence more
vulnerable to fractures
 Body…

5 surfaces:-
1. Superior surface
2. Inferior surface
3.Medial surface
4. Lateral surface
5.Posterior surface
 Superior Surface
Also called Trochlea
Supports body weight
and transmits load to the
inferior aspect of Tibial
Plafond
Wider anteriorly such
that medial and lateral
sides converge
posteriorly
 Contd..
Lateral Surface: Inferior Surface: It has
articulates with large oval concave facet
Lateral Malleolus ( Posterior Calcaneal
Medial Surface articular facet) for
articulates with articulation with
Medial Malleolus calcaneus.
 ANATOMY
• Lateral process : wedge
shaped and articulates with
posterior calcaneal facet
inferomedially and lateral
malleolus superolaterally
• Lateral Talocalcaneal
ligament originates here
• Posterior process has a
medial and lateral tubercle
separated by a groove for
the flexor hallucis longus
tendon
 ANATOMY

TARSAL
TARSAL CANAL: Lies just
CANAL
behind and below the tip of
medial malleolus
Formed of sulcus of inferior
surface of Talus and superior
sulcus of Calcaneum
Contents- Artery of Tarsal
canal and Talocalcaneal
interosseous ligament
 Tarsal Sinus

It is a space bounded:
Anteriorly: Talar head and neck
Posteriorly: Body of Talus
Inferiorly: Calcaneum
 ANATOMY
NO MUSCLE
ATTACHMENTS

Ligaments on the Medial

side
 Anterior Tibio-talar
ligament
 Posterior tibio-talar
ligament
 ANATOMY
ATTACHMENT

• Lateral side
 Anterior talo fibular
ligament
 ANATOMY…..
ATTACHMENTS

Posteriorly

Posterior talo fibular ligament

 Os Trigonum

Accessory bone located just posterior to lateral

tubercle of Post. Process
May exist as a separate ossicle or fused with lateral
tubercle of posterior process
Present in 50 % of normal foot
May be confused with fracture of lateral tubercle
 Blood Supply

 Talus is largely covered by articular cartilage, leaving

limited space for blood vessels to enter via capsular and
ligamentous attachments.
 Because of lack of muscular soft tissue attachments and
limited space available for vascular foramina, fractures of
Talus predispose the bone to osteonecrosis.
 The primary source of blood supply is the critical
anastomotic sling of vessels in the tarsal sinus and tarsal
canal, lying inferior to the neck of Talus
 Blood Supply
Vascular Supply consists of:
 Artery of Tarsal Canal (Post
Tibial artery)
 Arteries to sinus tarsi
(peroneal and dorsalis pedis
arteries)
 The Deltoid Artery (Post
Tibial artery) which supplies
the medial body
 Capsular and ligamentous
vessels and interosseous
anastomosis
Talar body is vulnerable to
osteonecrosis because of its
blood supply
 BLOOD SUPPLY OF TALAR BODY

 The artery of the tarsal canal which branches off the posterior
tibial artery is most consistent major supplier of blood to the
body of the talus.
 In tarsal canal it gives 4 to 6 direct vessels
 Deltoid artery ,branches off the artery of the tarsal canal and
directly supplies blood to medial ¼ to ½ of talar body,second
major supply to talar body
 Through intraosseous anastomosis, it has the potential to
supply blood to much greater area
 The artery of sinus tarsi which is more variable in size and
origin,supplies lateral 1/8 to ¼ of talar body.it is formed by
branches of perforating peroneal artery,dorsalis pedis
artery or anastomosis between two.
 BLOOD SUPPLY
Sagittal view (Medial)
Sagittal view (Middle)
Sagittal view (Lateral)
Coronal Section
Head
Coronal Section
Neck
Coronal Section
Body
 Surgical Approach

Depends on: Degree and location of comminution, need

for malleolar osteotomy, and preservation of Vascular
Supply.
1. Anteromedial Approach:
Most commonly used, incision is made directly over
the Talar neck and medial to the Anterior Tibial
Tendon
For fractures that extend more posteriorly into Talar
body, incision can be given midway between Tibialis
Anterior and Posterior Tendons to facilitate Medial
Malleolar Osteotomy
 Surgical Approach

2. Anterolateral Approach:
Less chance of damage to blood supply of Talus
Provides adequate exposure of fracture site
3. Direct Lateral Approach:
Often performed in conjunction with anteromedial
approach to facilitate exposure of Sub-talar joint
Caution should be taken to avoid damage to Sinus
Tarsi vessels
 Surgical Approach Contd…

4. Posterior Approach:
Useful to facilitate reduction and screw fixation of
Talar Neck fractures so as to achieve compression at
fracture site
5. Combined Approach:
Useful for fractures with extensive comminution
because sometimes it is difficult to achieve reduction
and fixation with single approach
 Osteonecrosis In Talar Neck Fracturs
S. Hawkins Description Incidence of
N. Type Osteonecrosis

1 I Undisplaced # of Talar Neck 0-13 %

2 II Displaced # with Subtalar Subluxation 20-50 %

or Dislocation

3 III Displaced # with Subtalar and Over 80 %

Tibiotalar subluxation or dislocation

4 IV Displaced # of with Subalar, Tibiotalar Worst Prognosis

and Talonavicular subluxation or
dislocation
 REFERENCES

Campbell’s Operative Orthopedics

Rockwood and Green’s Fractures in Adults
Netter’s Atlas of Human Anatomy
Millers Review of Orthopedics
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