Talar dome fracture classification
Talar fractures are relatively uncommon injuries, but they can be associated with significant complications. Because it articulates with important joints ankle, subtalar, and talonavicularit is one of the most important bones to stabilize and mobilize soon after a foot injury. Talar fractures are usually associated with hyperdorsiflexion of the ankle as the talar neck impacts the anterior margin of the tibia, such as in a motor vehicle accident or fall from height.
The talus articulates superiorly with the tibia and fibula in the ankle mortise and the calcaneus and navicular inferiorly.
Body weight is transmitted through the tibia to the superior surface of the talus. The anterior portion of the body is wider than the posterior portion, giving stability to the ankle. The neck of the talus connects to the head, which connects to the navicular and calcaneous and is the most vulnerable to fracture.
The talus has no muscular or tendinous attachments, but has a groove for the flexor hallicus longus tendon. The majority of the talus is covered by articular cartilage. It articulates with the spring ligament inferiorly along the distal medial aspect, the sustentaculum tali along the medial inferior aspect, and the deltoid ligament direct medially at the level of the ankle.
The major blood supply to the body is from the artery of the tarsal canal posterior tibial artery. Blood is also supplied by arteries to the sinus tarsi peroneal and dorsalis pedis arteries ; the deltoid artery posterior tibial arterywhich supplies the medial body; and the superior neck vessels anterior tibial artery. The most commonly used classification system is the Hawkins classification of talar neck fractures.
Other types of fractures include talar head fractures, talar body fractures, lateral process fractures, and posterior process fractures. Patients present with foot pain with painful range of motion and crepitus.
Swelling and tenderness of the talus and subtalar joint may be present. Other fractures of the foot and ankle are commonly seen, as these patients often have suffered a high-energy trauma. Also consider subtalar dislocation and total dislocation of the talus. AP, lateral, and mortise X-rays of the ankle and AP, lateral, and oblique views of the foot are highly recommended.
The canale view provides the best view of the talar arch. CT scan will assess fracture pattern, displacement, and articular involvement. CT, MRI, and technetium bone scan can be used to evaluate for occult fracture.
MRI can help detect avascular necrosis. Treatment for a Hawkins Type I fracture involves a short leg cast or boot for weeks and no weight-bearing for 6 weeks.
Lateral process fracture treatment is determined by displacement. If there is less than 2 mm displacement, use a short leg cast or boot for 6 weeks; the patient should be non-weight-bearing for 4 weeks. If there is more than 2 mm displacement, ORIF is recommended.
Posterior process fracture treatment is also determined by displacement. Non-displaced or minimally displaced posterior process fractures are treated with a short leg cast for 6 weeks and no weight-bearing for 4 weeks. For displaced fractures, ORIF is recommended. Nondisplaced talar head fractures are treated with a short leg cast molded to preserve the longitudinal arch; partial weight-bearing is recommended for 6 weeks. ORIF is necessary for displaced talar head fractures.
The prognosis for talus fractures is related to the degree of damage to its blood supply and the damage to the articular surfaces. Complications are related to the degree of displacement as well as risk of avascular necrosis.Recognition of the unique talar anatomy is important for correct diagnosis. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait.
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About Blog Go ad-free. Pathology Location talar head fractures talar neck fractures talar body fractures talar dome osteochondral fracture posterior talar process fracture lateral talar process fracture. Edit article Share article View revision history Report problem with Article. URL of Article. Article information. Systems: MusculoskeletalTrauma. Section: Gamuts.
Synonyms or Alternate Spellings: Talar fracture. Case 1 Case 1. Case 2: talar dome Case 2: talar dome.Average 4. He underwent operative fixation of his fracture. He presents at 2 months after surgery. He denies any constitutional symptoms and his pain is well controlled. On exam, his wounds are well healed with no erythema.Osteonecrosis, AVN Of The Talus - Everything You Need To Know - Dr. Nabil Ebraheim
Imaging is shown in Figure A. What can the patient be told about his condition? Tested Concept. On examination, he has moderate swelling and pain over the dorsum of the foot.
Talar Neck Fractures
The overlying skin is intact. Radiographs of the foot are seen in Figures A and B.
A CT scan image is seen Figures C. When consenting the patient for open reduction and internal fixation of this injury, what would you document as the most common complication? The body of the talus is extruded medially through a large linear open wound. Along with irrigation and debridement, what is the most appropriate definitive management of this injury?
Reduction of talar body, fracture fixation with smooth Steinman pins, and spanning fixator placement. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis.
Physical exam is notable for ambulation on the lateral border of the right foot with hindfoot varus, midfoot supination and diminished subtalar motion compared with the contralateral side.
Which of the following is an option for reconstruction of this patient's deformity? His current radiographs demonstrate a subchondral radiolucency of the dome of the talus. What is the next most appropriate course of action? During open reduction, what structure must be kept intact in order to protect the remaining blood supply to the talar body? A post-reduction radiograph is seen in Figure C.
Which of the following is the most appropriate treatment at this time? Which of the following is the most likely long-term complication even after anatomic reduction and stable fixation is achieved?
Which of the following radiographic features is a good prognostic factor for this injury? She sustains a talus fracture with associated dislocation of the subtalar joint and maintained congruence of the tibiotalar and talonavicular joints as shown in Figure A. The fracture has healed and she now has symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion.
What is the most likely deformity causing these symptoms?Free christmas dot to dot 1-20
Talar Neck Fractures. Brian Weatherford. Key Images. Hawkins III.One of the bones comprising the ankle is the talus bone which forms part of the foot. It derives the name "dome" because it sits cradled on top of the calcaneus with the top portion of the bone forming a dome like structure to allow for the up and down motion of the foot.
Ligaments attach the talus bone to the tibia and fibula bones to complete the ankle joint. In a severe ankle sprain, usually the medial and lateral ankle ligaments bear the brunt of the trauma, but sometimes the sprain may be so severe that the talus bone is displaced resulting in trauma to the bone and in many cases may be severe enough to cause a fracture within the talus.
Usually the top or dome is affected and thus we end up with a fracture of the dome. Since the talar dome is made of cartilage which is what allows the foot to bend up and down smoothly if it does not heal properly a small piece of cartilage may actually break off creating a defect in the otherwise smooth pearly nature of cartilage.
Swelling is a normal complaint in these conditions and the amount of swelling is usually proportional to the amount of activity one undertakes. An xray would be the first diagnostic test performed and often it is a good idea to take the same views of the other ankle for comparison purposes. If an xray proves to be uneventful and your doctor suspects a talar dome fracture, an MRI or CT scan may have to be performed for a more definitive view of the talus.
Once in a while, a local anesthetic may be injected directly into the joint, in an effort to see if the pain is coming from deep in the joint. If relief occurs, it may indicate the possibility of a talar dome fracture. It should be noted for clarification purposes that these type of talar dome fractures that create a loose body of cartilage are also known as an osteochondral defect.
The simplest treatment is to place the patient in a cast to keep the ankle joint from moving and allowing the defect to heal. The patient may or may not be able to bear weight, at the discretion of the doctor.
Oral anti-inflammatory medication or pain medication may be prescribed to reduce the discomfort associated with this condition. Once healing has occurred, physical therapy may be helpful to restore range of motion in the affected ankle joint.
During this period and possibly beyond, the patient may wear an ankle brace to better stabilize the joint and hopefully prevent further injury. In cases where the talar dome defect is too far into the joint and thus will never heal back on to the dome, surgical intervention may be necessary to remove the defect. Surgical treatment may involve a simple arthroscopic procedure to remove the bone chip to more complicated situations where there is open reduction where the ankle joint is opened, the talar defect is identified and put back into place and held there with internal fixation.
The problem with a talar dome fracture, particularly one that does not heal properly is that it further inflames the joint causing more damage to the ankle joint resulting in a more arthritic ankle. This situation could result in further pain, more limitation of motion in the joint and chronic swelling.
talar dome fracture
One of the complications of improper removal or poor re-positioning of the talar defect is that the bone chip may undergo avascular necrosis which means the bone chip actually dies due to lack of circulation and most certainly will then act as an irritant within the joint. Jennifer Hunterville, NC ….
So thank you very much!!! Liesbeth NY I am really, really impressed with your plain-speak explanations for the various conditions. Jacqueline NJ This was an extremely helpful site.
I have an appointment on the 18th and your info. Was right on target…. Jack Fla A well organized site containing much information written in a manner that the average reader can comprehend.Talar dome injuries are often missed on initial examination of a routine ankle sprain, only to be diagnosed weeks after the injury.
Injuries to the talar dome are called talar dome lesions, osteochondral lesions OLT'stranschondral fractures, osteochondral fractures, bone contusions, or osteochondral defects OCD's. Talar dome injuries occur equally in men and women. Symptoms Deep ankle pain following an injury to the ankle. Pain increases with increased activity or time spent on the feet. Bruising is common at the time of initial injury. Chronic swelling and deep ankle pain continue well past the time of initial injury.
Crepitus or catching of the ankle may be present. Description The human ankle is a complex, load-bearing joint that consists of just three bones. These three unique bones work in conjunction to provide the range of motion necessary to complete our daily activities such as walking, jumping, or running. Injuries of the ankle joint can be complex and debilitating.
This article discusses injuries of the talar dome. The talar dome is the rounded portion on the top of the talus that articulates with the bones of the leg tibia and fibula. Injuries of the talar dome were first discussed in the medical literature by Kappis in What Berndt and Hardy described was a classification of fractures found immediately beneath the surface of the cartilage of the talar dome.
Berndt and Hardy described four stages of transchondral fractures. Berndt and Harty Classification of Talar Dome Fractures: Stage I - Focal compression of the subchondral bone bone beneath the cartilage Stage II - Focal compression of the subchondral bone with partial detachment of a fragment of cartilage Stage III - Focal compression of the subchondral bone with a fully detached fragment of cartilage, still situated in place at the site of injury Stage IV - Focal compression of the subchondral bone with a fully detached fragment of cartilage, detached from the site of injury and floating in the joint space.
A newer method of classification of transchondral talar dome fractures which uses MRI as the basis of classification is called the Bristol classification. The Bristol classification was described by Hepple et. The mechanism of injury of a talar dome fracture involves focused load in one specific spot of the talar dome. In an inversion sprain of the ankle, the typical position of the foot and ankle at the time of injury is with the foot inverted and the ankle slightly plantarflexed.
As the talus rocks out of position during the sprain, the position of the foot and ankle places the posterior medial aspect of the talar dome in a position where focused load is applied by the tibia to the talus as the body weight pushes down, compressing the ankle and talar dome.
This mechanism of injury accounts for the fact that the As an analogy, think of the injury sustained by an apple when it falls from a tree. The skin of the apple appears normal, yet the underlying supporting structure of the flesh of the apple is damaged.
This example is very similar to what happens in a transchondral talar dome fracture. As the force of an injury is applied to the cartilage, the subchondral bone collapses in a localized fracture. As a result, the surface of the ankle joint becomes irregular. Motion on this irregular surface creates pain and inflammation within the joint. In severe cases, such as stages III and IV, the injured fragment of bone and cartilage becomes detached, creating even greater irregularities in the surface of the joint.
In a talar dome fracture, the injury to the subchondral bone crushes the normal blood supply to the site of the injury. The term aseptic necrosis is used to describe this type of an injury to the bone.
Aseptic no infection necrosis death of the talus is the single greatest influence that inhibits healing of talar dome fractures.
It's interesting to note that the cartilage of the ankle derives most of its nourishment from the fluid in the ankle joint, called synovial fluid, and not from the same blood supply that supplies the damaged bone.If the Account Holder is dissatisfied with any Service, or with any of the present BetBull Rules, the Account Holder's sole and exclusive remedy is to discontinue using the Services.
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Talus Fracture (other than neck)
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