Talus Fracture Types - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes fracture types of the Talus.
Anatomy of the talus
•Head
•Neck
•Body
•Lateral process
•Posterior process
•Medial & lateral tubercle
Posterior view of the ankle & hindfoot:
Posterior process of the talus is made up of a smaller medial tubercle and a larger tibial tubercle that is separated by a groove for the flexor hallucis longus muscle.
Fractures of the talus
•Head fracture
•Neck fracture
•Body fracture
•Lateral process fracture
•Posterior process fracture
•Osteochondral fracture
The main blood supply of the talus is the artery of the tarsal canal. It comes from the posterior tibial artery and supplies the majority of the talar body. The deltoid branch from the posterior tibial artery is an important branch involving badly displaced fractures. It supplies the medial part of the talar body. Interruption of the blood supply causes death of the bone, AVN and nonunion.
Head fracture: 5-10% of all talar fractures are head fractures.
Neck fracture: the fracture line exits inferior surface anterior to the lateral process. There are four types of talar neck fractures.
•Type I: non-displaced. 15% AVN
•Type II: fracture with subtalar dislocation or subluxation. 50% AVN.
•Type III: fracture with subtalar and tibiotalar dislocation. 90% AVN.
•Type IV: fracture with subtalar and tibiotalar dislocation and talonavicular subluxation. 90-100% AVN.
Body fracture
The fracture line exists inferior surface behind the lateral process. 25% AVN & 25% AVN with subtalar dislocation.
Lateral process fracture
•CT scan is helpful for lateral process fractures. There are three types of lateral process fractures that are called “snowboarder’s injuries” .
•Type I: avulsion
•Type II: large fragment: especially involving the joint needs surgery.
•Type III: comminuted. Small and comminuted fragments treated with a cast.
Posterior process fracture
•Rare injury
•Usually missed on initial x-rays
•Misdiagnosed as an ankle sprain
•Mechanism of injury: usually forcible plantar flexion of the ankle (nutcracker injury).
•Differential diagnosis: Os Trigonum.
•Treatment: if fracture is missed, painful nonunion and instability of the subtalar joint may result. CT scan is helpful. Lateral view in 30 degrees external rotation may show the fracture. Larger fragment involving the joint requires surgery. Smaller fragment; immobilize in a cast or a boot.
Osteochondral lesion:
•Osteochondral lesions can occur in the talus. It may require surgical treatment. Can occur in severe trauma to the ankle or severe ankle sprain.

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