Summary Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Treatment is generally nonoperative with immobilization for minimally displaced injuries and surgical reduction and fixation for displaced and intra-articular fractures. Epidemiology Incidence rare login to view 2 more bullets Anatomic location talar body fractures login to view 1 more bullet lateral process fractures login to view 1 more bullet talar head fracture login to view 1 more bullet Etiology Mechanism talar body login to view 1 more bullet lateral process of talus login to view 2 more bullets Anatomy 3D Anatomy of talus Talus has no muscular or tendinous attachments Articulation there are 5 articulating surfaces login to view 2 more bullets talar head articulates with login to view 2 more bullets lateral process articulates with login to view 3 more bullets posterior process consist of medial and lateral tubercle separated by groove for FHL Blood supply because of limited soft tissue attachments, the talus has a direct extra-osseous blood supply sources include login to view 12 more bullets Classification Anatomic classification Anatomic classification Lateral process fracture Type 1 Fractures do not involved the articular surface Type 2 Fractures involve the subtalar and talofibular joint Type 3 Fractures have comminution Posterior process Posteromedial tubercle Avulsion of the posterior talotibial ligament or posterior deltoid ligament Posterolateral tubercle Avulsion of the posterior talofibular ligament Talar head fracture Talar body fracture Physical Exam Symptoms pain login to view 1 more bullet Physical exam provocative tests login to view 1 more bullet Imaging Radiographs recommended views login to view 10 more bullets CT scan indicated when suspicion is high and radiographs are negative login to view 1 more bullet helpful to determine degree of displacement, comminution, and articular congruity MRI can be used to confirm diagnosis when radiographs are negative Treatment Nonoperative SLC for 6 weeks login to view 7 more bullets Operative ORIF/Kirshner wire Fixation login to view 7 more bullets fragment excision login to view 4 more bullets Technique ORIF/Kirshner Wires approaches login to view 12 more bullets Fragment excisions incompetence of the lateral talocalcaneal ligament is expected with excision of a 1 cm fragment login to view 1 more bullet Complications AVN Hawkins sign (lucency) indicates revascularization login to view 1 more bullet Talonavicular arthritis posttraumatic arthritis is common in all of these fractures this can be treated with an arthrodesis of the talonavicular joint Malunion Chronic pain from symptomatic nonunion may have pain up to 2 years after treatment Subtalar arthritis found in 45% of patients with lateral process fractures, treated either non-operatively or operatively login to view 1 more bullet Prognosis Lateral process injuries have a favorable outcomes with prompt diagnosis and immediate treatment