Talus Fracture of the Ankle

The talus is one of the important bones that form the ankle joint. It serves as an important link between the leg and the foot. The talus is also a unique bone as over one-half it is covered with cartilage that provides cushion and allows bones to move more freely against each other. The talus moves not only at the ankle joint but also below the ankle at the subtalar joint and in the midfoot at the talonavicular joint. Injuries to the talus can have a significant effect on the motion of the ankle and foot joints and limit the ability to walk and bear weight.

Talus fractures were almost unheard of a hundred years ago. The first series of talus fractures was described in men who were injured in the British Royal Air Force in the early 1900s. The term "aviators astragalus" was used to describe these fractures that happened as old war planes made crash landings. Today, talus fractures are seen in car and motorcycle crashes, snowboarding accidents, and severe falls.

Patients who have a talus fracture have significant ankle pain, difficulty bearing weight on the ankle, and swelling around the ankle joint. Patients should have immediate X-ray evaluation to determine if there is a talus fracture or any other injury to the ankle.

The most common symptoms of talus fractures include:

• Swelling around the ankle joint
• Pain with movement of the ankle
• Fracture blisters
• Bruising of the skin
• Inability to place weight on the joint

Treatment of a talus fracture depends on the extent of the injury. If the fracture is not out of position, a cast may be sufficient for treatment. If the fracture is out of position, then surgery may be recommended to realign the broken bones and stabilize them with screws or pins.

There are three major complications that commonly occur with talus fractures. These problems are ankle arthritis, fracture malunion, and osteonecrosis. Other potential problems include infection, nonunion, foot deformity, and chronic pain.

Arthritis is common after a talus fracture because so much of the bone is covered with cartilage. Arthritis may occur above the talus at the ankle joint, or below the talus at the subtalar joint. When the cartilage is injured, the normally smooth joint surface becomes uneven. These irregularities can lead to accelerated wear in the joint, and ultimately to arthritis. Even with surgical treatment of a talus fracture, the development of arthritis is common.

Malunion means that the break has healed, but the position where the bone healed is not anatomically correct. This can lead to a number of different problems, especially with foot fractures where altered alignment can lead to long-term problem and difficulty walking.

Osteonecrosis, or avascular necrosis, is a problem that is found commonly in the talus. Because of unusual blood supply to the talus bone, it can be disrupted when the bone is injured in a fracture. Without a blood supply, the bone cells can die (osteonecrosis) and the bone cannot heal (nonunion). Even with surgery to realign the bone and hold the fragments in position, damaged blood supply may lead to this problematic complication.

The recovery from a talus fracture is lengthy because until the bone is healed, you cannot place weight on the extremity. Therefore, most talus fractures require a minimum of eight to 12 weeks of protection from weight-bearing. In more significant injuries, the time may be longer. Studies have shown that the ultimate outcome of patients correlates well with the extent of the initial injury.

After your ankle has fused properly, you can start a rehab program of physical therapy to regain range of motion, stability, and strength in the ankle joint. You may have to use a cane or wear a special boot and may not be able to put your full weight on your foot for two to three months.

Only time will tell if a patient is going to develop arthritis or osteonecrosis, therefore, your doctor will obtain periodic x-rays to determine the health of the bone, and the adequacy of healing.