Talus fracture fixation

Patients with talus fractures can be treated non operatively in some cases, but where there is significant displacement fixation is recommended.

This is performed through multiple incisions to align the bone and fixation is placed in such a way to minimise risk of cartilage damage and interruption to the blood supply.

Surgery to realign the ankle bone focuses on restoring the normal shape of the bone then allowing it to heal. In some cases this can be done via a percutaneous technique (stab incisions), but usually it is an open surgery

Mr. Talia is always happy to see patients at short notice with foot and ankle injuries and if surgery is required this can typically be organised in a safe manner within recommended timeframes for the best outcome.

Figure 1: internal fixation of displaced talus fracture with screws and/or plates

Figure 2: schematic (Hawkin’s classification) of talar neck fractures of increasing severity

Image from: https://www.rch.org.au/clinicalguide/guideline_index/fractures/Talus_Fractures__Emergency_Department/

Post-operative plan:

  • Surgery is typically an overnight stay

  • A nerve block of the leg is administered to help with pain

  • 0-2 weeks: elevation at home, plaster cast or CAMboot

  • 2-6 weeks: non weight bearing in CAMboot

  • 6-10 weeks onwards: weight bearing in moon boot

  • >12 weeks: progress to strengthening

Download post-operative care guide

 

Risks of surgery

  • Swelling, stiffness

  • Infection and wound breakdown

  • Blood clots

  • Scar sensitivity, numbness in the foot

  • Ongoing pain

  • Progression to arthritis of the subtalar joint and/or ankle joint - necessitating further surgery

  • Removal of implants in most patients (secondary surgery)

A unique complication to talus fractures is avascular necrosis where the bone dies off due to blood supply damage at the time of injury. this is closely monitored for with X-rays in the post operative period. This can be as high as 75% for some injuries.

Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970 Jul;52(5):991–1002.

Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar Neck Fractures: Results and Outcomes: The Journal of Bone and Joint Surgery-American Volume. 2004 Aug;86(8):1616–24.