Fracture talus

Q: Describe the blood supply of talus?

The talus has both extraosseous and intraosseous blood supply derived from the
posterior tibial, anterior tibial and peroneal arteries, as well as anastomotic vessels
from the surrounding capsule and ligaments:

A) Extraosseous supply: Branches from the three major vessels anastomose to

form a rich vascular network that covers the entire talus and thereby supply it
with a very adequate blood supply.
B) Intraosseous supply: The head of the talus is richly supplied by intraosseous
vessels. The body of the talus is supplied mainly by vessels which enter the
talar neck from the tarsal canal and then run retrograde from distal to
proximal.

In fractures of the talar neck intraosseous vessels are divided and if the fracture is
displaced, the extraosseous plexus too may be damaged and the body of the talus is
at risk of ischemia and avascular necrosis.
Q: What are the various types of talar fractures? [Apley’s p-922]
A) Fracture of the head of the talus.
B) Fracture of the neck of the talus (Hawkins and modified by Canale):
a. Type I – undisplaced.
b. Type II – little displaced and associated with subluxation or dislocation
of the subtalar joint.
c. Type III – displaced, with dislocation of the body of the talus from the
ankle joint
d. Type IV – displaced vertical talar neck fracture with associated
talonavicular joint disruption.
C) Fracture of the body of the talus.
D) Fracture of the bony processes of the talus (lateral and posterior processes).
E) Osteochondral fracture.
Q: What is the prognosis and complications of fracture of talus?
The prognosis of talar fracture is dependant on the site of fracture and the degree of
initial displacement.
Complications:
1. Avascular necrosis of the body fragment is the main complication which varies
according to the degree of displacement.
 Hawkins type I: AVN occur in about <10% cases.
 Hawkins type II: AVN occur in about 30-40% cases.
 Hawkins type III: AVN occur in about >90% cases.
2. Skin necrosis
 3. Malunion
4. Delayed union, nonunion.
5. Infection and osteomyelitis
6. Secondary osteoarthritis [in >50% of patients with talar neck fractures]
Q: What are the approaches to talus?
Talus is exposed mainly by anteromedial approach but can be approached by
anterolateral and posterolateral approach too.