Talus fracture everything you need to know

Tất cả những gì cần biết về gãy xương sên: Định nghĩa, Dịch tễ, Triệu chứng, Chẩn đoán, Chẩn đoán phân biệt, Biến chứng, Điều trị, Biến chứng sau mổ, Chăm sóc sau mổ. Bài viết bằng tiếng anh được tổng hợp từ nhiều nguồn tài liệu đáng tin cậy từ trong nước và nước ngoài

Talus fracture and dislocation

Vũ Hồng Duyên

Lê Thị Lan Anh

Lê Đức AnhHoàng Trường Sơn

Lê Huỳnh ĐứcNguyễn Văn Hậu

1 Overview

2 Anatomy

Anatomy Position

The talus is the bone in the back of the foot that

connects the leg and the foot It sits within the ankle

"mortise" or hinge, which is made up of the two leg

bones, the tibia and fibula

It joins with the two leg bones (tibia and fibula) to

form the ankle joint and allows for upward and

downward motion of the ankle

Joints

 There are three joints:

 The ankle, which allows the

up-and-down motion of the foot with the leg

 The subtalar joint, which allows for

side-to-side movement

 The talonavicular joint, which has a

complicated biomechanical function

that controls flexibility of the foot and

the arch of the foot

 The talus has no muscular attachments

and is mostly covered with cartilage

AnatomyBlood Supply

 Blood supply of talus is not very profuse

because of lack of muscular attachment The

vascular supply is dependent on fascial

structures to reach the talus, therefore,

capsular disruptions may result in

osteonecrosis

 The vascular supply to the talus consists of:

Arteries to the sinus tarsi ( peroneal and dorsalis

pedis arteries)

An artery for the tarsal canal (posterior tibial

artery)

The deltoid artery( posterior tibial artery),

which supplies the medial body

Capsular and ligamentous vessels and

intraosseous anastomoses

Anatomy Nerve supply

 Talus is innervated by branches from deep

peroneal, posterior tibial, and sural nerves

3 Talus examination and diagnostic

Talus examination and diagnostic

 Inspection

Observe all surfaces of the ankles and feet, noting any deformities, nodules,

swelling, calluses, or corns.

 Palpation

With your thumbs, palpate the anterior aspect of each ankle joint, noting any

bogginess, swelling, or tenderness.

Also feel along the Achilles tendon, the heel and medial and lateral malleosus.

Palpate the metatarsophalangeal joints for tenderness Compress the forefoot

between the thumb and fingers Exert pressure just proximal to the heads of the

first and fifth metatarsals.

Palpate the heads of the five metatarsals and the grooves between them with your

thumb and index finger Place your thumb on the dorsum of the foot and your index

finger on the plantar surface

Talus examination and diagnostic

The Ankle (Tibiotalar) Joint

Dorsiflex and plantar flex the foot at the

ankle.

Talus examination and diagnostic

The Subtalar (Talocalcaneal) Joint Stabilize the

ankle with one hand, grasp the heel with the

other, and invert and evert the foot by turning

the heel inward then outward

Talus examination and diagnostic

The Transverse Tarsal Joint

Stabilize the heel and invert and evert the

forefoot

Talus examination and diagnostic

Talus fracture symptoms:

Ankle pain

Diffuse swelling of the hindfoot may be present, with tenderness to palpation of the talus and subtalar joint

Loss of pulse and sensation on palpation

Decreased range of movement

Pain on motion and elicit crepitus

Associated fractures of the foot and ankle

Talus examination and diagnostic

Imaging test

X-rays X-rays are the most common and widely available diagnostic imaging

technique An x-ray can show if the bone is broken and whether there is

displacement (the gap between broken bones) It can also show how many pieces of bone there are.

Talar neck fracture

Talar lateral process fracture

Talar posterior process fracture

4 Classification

Classification of talar neck fractures according to Hawkins

 Type 1 - undisplaced vertical fracture of the neck

 Type 2 - displaced fracture with partial or total dislocation of the body of talus from the calcaneal (subtalar joint)

talo- Type 3 - displaced fracture with dislocation of the body of talus from the talo-calcaneal (subtalar joint) and ankle joint

 Type 4 - displaced fracture with dislocation of the head of talus from the talo-calcaneal (subtalar joint) and talo-navicular joint

 Classification of talar body fractures according to Hawkins

 Shear type I (A, B)

 Shear type II (C)

 Crush (D)

5 Treatment

 Nonoperative treatment

 Operative treatment

Nonoperative treatment

Only used for non displaced or minimally displaced fractures

Patient has to wear a short leg cast or boot and be non weight-bearing for an amount of time

Talar neck frature:

Wear short leg cast or boot for 8 to 12 weeks and remain non–

weight bearing for 6 weeks until clinical and radiographic evidence of

fracture healing is present.

Lateral Process Fractures

Wear short leg cast or boot for 6 weeks and be non–weight bearing for at least 4 weeks.

Posterior Process Fractures

Wear short leg cast for 6 weeks and be non–weight bearing for at least 4 weeks.

Talar Head Fractures

Wear short leg cast molded to preserve the longitudinal arch and be partial weight bearing for 6 weeks An arch support is worn in the shoe to splint the talonavicular articulation for 3 to 6 months.

Treatment

Operative treatment:

Mostly used to treat talus fractures, consist of

open reduction and internal fixation (ORIF)

Anteromedial:

This approach may be extended from a limited

capsulotomy to a wide exposure with malleolar

osteotomy (as the fracture progresses toward the

body) The internal is just medial to the anterior

tibial tendon

This approach allows visualization of the talar

neck and body

Care must be taken to preserve the saphenous

vein and nerve and, more importantly, the

deltoid artery

Posterolateral:

This approach provides access to posterior process and

talar body The interval is between the peroneus brevis

and the flexor hallucis longus

The sural nerve must be protected It is usually necessary

to displace the flexor hallucis longus from its groove in

the posterior process to facilitate exposure.

Anterolateral:

This approach allows visualization of the sinus tarsi,

lateral talar neck, and

subtalar joint

Inadvertent damage to the artery of the tarsal sinus can

occur through this approach.

Treatment

Combined anteromedial–anterolateral:

This is often used to allow maximum visualization of the

talar neck.

Treatment

Internal fixation

Treatment

 Talar neck fracture:

ORIF is performed using lag screws or wires through any approach

 Lateral Process Fractures:

ORIF is performed using lag screws or wires through a lateral approach

 Posterior Process Fractures:

ORIF is recommended if the fragment is large; primary excision is performed if the fragment is small; a posterolateral approach may be used

 Talar Head Fractures:

ORIF is indicated, with primary excision of small fragments through an anterior or anteromedial approach Headless screws or buried implants will be needed for this intra-articular fracture

Treatment

Physical Therapy

Specific physical therapy exercises can improve the range of motion in the foot and ankle, and strengthen supporting muscles

Treatment

 Lynn S Bickley, Bates' Guide to Physical Examination and History-Taking (11th edition)

 Kenneth A Egol , Kenneth J Koval , and Joseph D Zuckerman, Handbook of fractures( 5th

edition)

Thank you