Updated: 12/28/2021

Talus Fracture

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  • Snapshot
    • A 16-year-old woman presents to her pediatrician due to right ankle pain. She reports that prior to symptom onset she was in cheerleading practice, where she fell from an elevated position but landed on her right foot. Since the fall she has experienced severe pain, swelling of the ankle, and an inability to bear weight on the affected foot. On physical exam, there are no open wounds. The right ankle is swollen and tender to palpation. Range of motion of the ankle is limited and dorsalis pedis and posterior tibialis pulses are present. Strength exam is limited by pain. A three-view ankle series radiograph of the ankle demonstrates a talus fracture.
  • Introduction
    • Clinical definition
      • fracture of the talus bone
  • Epidemiology
    • Incidence
      • more common in snowboarders
  • Etiology
    • Falling from a significant height
    • High energy trauma
    • Pathoanatomy
      • the talus bone is dense due to its function in transferring force from the lower leg to the foot and bearing the body's weight
        • the talus bone is composed of the
          • head
          • neck
          • body
      • high force impact is transferred to the talus bone and results in fracture
  • Presentation
    • Symptoms
      • pain and swelling in the ankle
      • inability to bear weight on the affected foot
    • Physical exam
      • ankle swelling
      • limited range of motion
      • tenderness to palpation
  • Imaging
    • Radiography
      • indication
        • imaging modality used if there is suspicion of a talus fracture
    • Computerized tomography (CT) scan
      • indication
        • obtained after the fracture is confirmed or if the radiography is negative when there is a high clinical suspicion for a talus fracture
  • Differential
    • Soft tissue injury
      • differentiating factor
        • lack of fracture on imaging
  • DIAGNOSIS
    • Making the diagnosis
      • this is a clinical diagnosis supported by imaging
  • Treatment
    • Treatment depends on the type of talus fracture
    • Conservative
      • non-weight bearing cast
        • indication
          • typically used in non-displaced fractures
    • Operative
      • orthopedic surgery
        • indication
          • typically in displaced fractures and certain types of talar fractures (e.g., talar body fractures)
  • Complications
    • Avascular necrosis
    • Osteoarthritis
    • Malunion or nonunion
  • Prognosis
    • Higher-energy injuries are associated with a worse prognosis
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(M2.OR.16.4686) A 67-year-old male presents to your office one day after an injury. Yesterday he tried to play basketball with his grandchildren and he was doing well until he jumped to get the ball and landed awkwardly on his right foot, after which he could not bear weight on his foot. On exam, his right foot is significant for swelling with tenderness to palpation anterior to the Achilles tendon. The patient has no tenderness over his medial or lateral malleoli. Figure A is a radiograph of his right foot with the area of traumatic injury. What is the most likely diagnosis?

QID: 107368
FIGURES:

Gastrocnemius muscle tear

20%

(3/15)

Soleus muscle tear

7%

(1/15)

Fibular fracture

0%

(0/15)

Tibial fracture

0%

(0/15)

Talus fracture

73%

(11/15)

M 6 E

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Evidence (3)
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