Flashcards in Talus anatomy and body fractures Deck (28):
How much is the talus covered in articular cartilage ?
GREATER THAN HALF
Does the talus have any muscle or ligament attachments?
Name the 3 main blood supply to the talus?
POSTERIOR TIBIAL ARTERY
DORSALIS PEDIS ARTERY
PERFORATING PERONEAL ARTERY
What supplies the TALAR BODY?
ARTERY OF TARSAL CANAL from POST. TIBIAL ARTERY
DELTOID ARTERY also comes off post tiibial
What supplies the Talar Head and Neck?
ARTERY OF TARSAL SINUS- from the PERFORATING PERONEAL ARTERY
What landmark determines a talar body fracture?
POSTERIOR to the LATERAL PROCESS
What joints does a talar body fracture involve ?
Describes the types of talar body fractures?
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
What is the tx of undisplaced talar body fractures ? What is the criteria of undisplacement?
SLC 6 weeks
less than 2mm displaced
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
What approaches would be made for a lat process fracture orif?
What approaches would be made for a post process fracture orif?
What approaches would be made for a talar body fracture orif?
dual incision MEDIAL AND LATERAL
What are the complication of the fracture?
AVN - diagnosed by SCLEROSIS ON XRAY
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
What is the most common talus fracture?
Talar neck fractures
What is the mechanism of talar neck fractures?
FORCED DORSIFLEXION ADN AXIAL LOAD
What is the talar neck classification?
HAWKINS CLASSIFICATION- on joint dislocation and risk of AVN
What is a HAWKINs type I and its risk of avn?
A NONIDSPLACED FRACTURE
AVN RISK 0-13%
How do you tx hawkins type 1?
A short leg cast NWB 6-8 weeks
Regular xrays to confirm position
What is a HAWKINs type 2 and its risk of Avn?
Displacement of talar fracture and ST dislocation/subluxation
AVN risk 30-45%
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
What is a HAWKINs type 3 and its risk of Avn?
Displacement of talar neck fracture with Subtalar and tibiotalar joint dislocations
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
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%
How do you tx hawkins 4?
Urgent ORIF 2 incisions, aim for anatomical reduction. NBW 10-12 weeks