Review Question - QID 981

Figure A represents a type 3 Hawkins talar neck fracture. A type 3 injury is defined as a displaced fracture of the talar neck with dislocation of body of talus from both the subtalar joint and the tibiotalar joint. In these injuries, the talar body fragment typically rotates around intact deltoid ligament fibers to lie in soft tissues with the fracture surface pointing laterally and cephalad. Often, the deltoid branch of the posterior tibial artery, which lies between the leaves of the deltoid ligament and supplies up to 1/2 of the medial talar body, is the only remaining blood supply. Therefore, the deltoid ligament must be preserved to lower the risk of avascular necrosis. When performing a medial malleolar osteotomy, the deltoid ligament must remain in continuity with the malleolus to prevent disruption of the blood supply.

The review article by Fortin et al discusses talar blood supply, injury mechanisms and classifications, and treatment options. They state that the main artery to the body of the talus is the artery of the tarsal canal, which is a branch of the posterior tibial artery. The peroneal and anterior tibial artery also contribute branches to the talus.

Illustration A and B show the arterial network of the talus.