II. Epidemiology
- Incidence: 3-5% of ankle and Foot Fractures
III. Mechanism
- Acute Trauma (rare in sports)
- High energy foot injury (fall from height, Motor Vehicle Accident)
- Severe foot dislocations (associated with talar neck Fracture)
-
Snowboarder's Fracture (Lateral process Talus Fracture)
- Often misdiagnosed as Lateral Ankle Sprain
- Occurs with acute dorsiflexion and foot inversion under axial load
- Other Fractures
- Talar Stress Fracture (rare)
- Talar Dome Fracture
- Posterior Talar Fracture
- Osteochondritis Dissecans of Talus
IV. Symptoms
- Ankle pain
- Unable to bear weight
V. Signs
- Ankle and proximal foot Ecchymosis, swelling, tenderness and decreased range of motion
VI. Imaging
- Initial XRay Imaging (Test Sensitivity 74%)
- Ankle XRay
- Foot XRay
- XRay Foot - Canale View (talar neck view)
- CT Imaging Indications
- High index of suspicion for Talus Fracture despite negative XRay
- Define Fracture to evaluate articular involvement, comminution and for surgical planning
VII. Complications
- Subtalar Dislocation (risk of Avascular Necrosis)
- Tibiotalar Dislocation (risk of Avascular Necrosis)
- Osteochondritis Dissecans of Talus (Avascular Necrosis)
- Ipsilateral limb Fracture
- Foot Osteoarthritis (50% risk)
- Infection (20% risk)
- Nonunion (5 to 10% risk)
VIII. Management
- Consult orthopedics or podiatry
- Emergency Management
- Talar body Fractures
- Talar neck Fractures
- Emergent orthopedic Consultation if displaced talar neck Fracture
- Lateral Process Talar Fracture (Snowboarder's Fracture)
- Talar Stress Fracture
- Relative rest, support shoe, walking boot (CAM Boot), or non-weight bearing
- Resolution may require up to 6 months
- Progressive return to weight bearing
- Use Ankle Brace after return to activity
IX. References
- Kiel (2022) Crit Dec Emerg Med 36(9): 18-9
- Feden and Kiel (2017) Crit Dec Emerg Med 31(11): 3-10
- Koenig and Clanton in Madden et al (2010) Netter's Sports Medicine, Saunders, Philadelphia, p. 469-70
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Related Studies
Concepts | Injury or Poisoning (T037) |
ICD10 | S92.1 |
SnomedCT | 208707007, 263246003 |
German | Fraktur des Talus |
Korean | 목말뼈의 골절 |
English | Astragalus, Fracture of talus, fractures talus, fracture talus, talus fracture, of talus fracture, fracture of tarsal bone(s) talus, fracture of talus, fracture of talus (diagnosis), Fracture of talus (disorder), astragalus; fracture, fracture; ankle, talus, fracture; astragalus, fracture; talus, talus; fracture, ankle; fracture, talus |
Spanish | fractura del astrágalo, fractura del astrágalo (trastorno), fractura de astrágalo, fractura de astrágalo (trastorno) |
Dutch | astragalus; fractuur, enkel; fractuur, talus, fractuur; astragalus, fractuur; enkel, talus, fractuur; talus, talus; fractuur, Fractuur van talus |