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