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 less than 1% of all fractures second most common tarsal fractures after calcaneus fxs Anatomic location talar body fractures account for 13-23% of talus fractures lateral process fractures account for 10.4% of talus fractures talar head fracture least common talus fracture Etiology Mechanism talar body injuries often result from high energy trauma, with the hindfoot either in supination or pronation lateral process of talus injuries result from forced dorsiflexion, axial loading, and eversion with external rotation login to view 1 more bullet Anatomy 3D Anatomy of talus Talus has no muscular or tendinous attachments Articulation there are 5 articulating surfaces seventy percent of the talus is covered by cartilage inferior surface articulates with posterior facet of calcaneus talar head articulates with navicular bone sustenaculum tali lateral process articulates with posterior facet of calcaneus lateral malleolus of fibula login to view 1 more bullet 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 posterior tibial artery login to view 4 more bullets anterior tibial artery login to view 1 more bullet perforating peroneal arteries via artery of tarsal sinus login to view 1 more bullet deltoid artery (located in deep segment of deltoid ligament) login to view 2 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 lateral process fractures often misdiagnosed as ankle sprains Physical exam provocative tests pain aggravated by FHL flexion or extension may be found with a posterolateral tubercle fractures Imaging Radiographs recommended views AP and lateral login to view 1 more bullet Canale View login to view 5 more bullets careful not to mistake os trigonum (present in up to 50%) for fracture may be falsely negative in talar lateral process fx CT scan indicated when suspicion is high and radiographs are negative best study for posterior process fx, lateral process fx, and posteromedial process fx 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 indications login to view 4 more bullets technique login to view 1 more bullet Operative ORIF/Kirshner wire Fixation indications login to view 6 more bullets fragment excision indications login to view 3 more bullets Technique ORIF/Kirshner Wires approaches lateral approach login to view 2 more bullets posteromedial approach login to view 2 more bullets posterolateral approach login to view 3 more bullets combined lateral and medial approach login to view 1 more bullet Fragment excisions incompetence of the lateral talocalcaneal ligament is expected with excision of a 1 cm fragment this is biomechanically tolerated and does not lead to ankle or subtalar joint instability Complications AVN Hawkins sign (lucency) indicates revascularization lack of Hawkins sign with sclerosis is indicative of AVN 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 anatomic reduction of the articular surface can decrease incidence Prognosis Lateral process injuries have a favorable outcomes with prompt diagnosis and immediate treatment