Talus anatomy and body fractures Flashcards Preview

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Flashcards in Talus anatomy and body fractures Deck (28):
1

How much is the talus covered in articular cartilage ?

GREATER THAN HALF

2

Does the talus have any muscle or ligament attachments?

No

3

Name the 3 main blood supply to the talus?

POSTERIOR TIBIAL ARTERY
DORSALIS PEDIS ARTERY
PERFORATING PERONEAL ARTERY

4

What supplies the TALAR BODY?

ARTERY OF TARSAL CANAL from POST. TIBIAL ARTERY
DELTOID ARTERY also comes off post tiibial

5

What supplies the Talar Head and Neck?

DORSALIS PEDIS
ARTERY OF TARSAL SINUS- from the PERFORATING PERONEAL ARTERY

6

What landmark determines a talar body fracture?

POSTERIOR to the LATERAL PROCESS

7

What joints does a talar body fracture involve ?

SUBTALAR
TIBIOTALAR

8

Describes the types of talar body fractures?

LATERAL PROCESS
POSTERIOR PROCESS
TALAR HEAD
TALAR BODY

9

What xrays views are helpful in identification of the fracture?

AP and LATERAL
CANALe view- MAX EQUNIUS, 15 DEGREES PRONATED, XRAYS 75 DEGREES CEPHALD OFF HORIZONTAL

10

What is the tx of undisplaced talar body fractures ? What is the criteria of undisplacement?

SLC 6 weeks
less than 2mm displaced

11

What is the TX of displaced talar body fractures? What is the criteria of displacement?

Surgery- ORIF/ K wires
if displacement >2mm
Can excise comminuted peices of post process/ lat process

12

What approaches would be made for a lat process fracture orif?

LATERAL

13

What approaches would be made for a post process fracture orif?

POSTERIOLATERAL

14

What approaches would be made for a talar body fracture orif?

dual incision MEDIAL AND LATERAL

15

What are the complication of the fracture?

AVN - diagnosed by SCLEROSIS ON XRAY
TALONAVICULAR ARTHRITIS

16

What is HAWKING'S sign? When is it best seen?

SUBCHONDRAL LINEAR LUCENCY OF TALAR DOME on xray. A sign of REVASCULARISATION
6-8 weeks post injury

17

What is the most common talus fracture?

Talar neck fractures

18

What is the mechanism of talar neck fractures?

FORCED DORSIFLEXION ADN AXIAL LOAD

19

What is the talar neck classification?

HAWKINS CLASSIFICATION- on joint dislocation and risk of AVN

20

What is a HAWKINs type I and its risk of avn?

A NONIDSPLACED FRACTURE
AVN RISK 0-13%

21

How do you tx hawkins type 1?

A short leg cast NWB 6-8 weeks
Regular xrays to confirm position

22

What is a HAWKINs type 2 and its risk of Avn?

Displacement of talar fracture and ST dislocation/subluxation
AVN risk 30-45%

23

How do you tx hawkins 2?

Closed reduction- plantarfelxion foot and heel manipulation then slc nwb 6-8 wks
ORIF is displaced. nwb 10-12 weeks post surgery

24

What is a HAWKINs type 3 and its risk of Avn?

Displacement of talar neck fracture with Subtalar and tibiotalar joint dislocations
AVN 90-100%

25

How do you tx hawkins 3?

ORIF- 2 incisions
anteromedial - between tibilalis ant and post tibialis - preserve soft tissue including deltoid as has deloid artery to talar body in it
anterolateral between tibia and filbular prox and inline with 4th ray- elevate EDB
anatomical reduction of fragments
NWB cast post op 10-12 weeks

26

What is a HAWKINs type 4 and its risk of Avn?

Displacement of talar neck fracture with subtalar, tibiotalar and talonavicular joint dislocation
AVN risk 90-100%

27

How do you tx hawkins 4?

Urgent ORIF 2 incisions, aim for anatomical reduction. NBW 10-12 weeks

28

What are the complications of talar neck fractures?

AVN
POST TRAUMATIC ARTHRITIS- SUBTALAR 50%
VARUS MALUNION- 25-30%
NON UNION (TYPE 3-4) 13%