The talus bone makes up part of the ankle joint, as well as the subtalar and talonavicular joints. The ankle joint allows for up-and-down motion while the subtalar and talonavicular joints allow for side-to-side motion. A
talar fracture is a break in the talus
bone that involves one or more of these important joints.
The goal of talar fracture surgery is to bring the bone pieces back together and restore the normal bone shape. This surgery reduces the chance of developing arthritis or losing blood supply to the bone, compared to leaving the pieces out of place.
Your foot and ankle orthopaedic surgeon may recommend talar fracture surgery if the bone fragments have shifted out of place, if the bone has broken through skin, if the nerves or blood vessels are damaged, or if there is an uneven cartilage surface in the ankle or subtalar joints.
Surgery should not be performed in fractures that haven't shifted, patients who are sick or elderly and cannot risk having anesthesia, or in patients who have very injured or burned skin over the fracture.
Talar surgery puts the talus bone back together as best as possible. Every break has a unique fracture pattern, so every surgery requires its own tailored approach.
During surgery you may have a general anesthetic and be completely asleep or have your leg numbed with a nerve block. Most surgeons will place a tourniquet on the leg above or below the knee. Your surgeon will make one or two incisions over the bone on either side of the foot, or even at the back of your ankle.
There are important tendons, nerves, and blood vessels that are carefully moved out of the way in order to expose the fractured bone.
Your foot and ankle orthopaedic surgeon uses many different tools to realign the broken pieces of bone and move the bone into the appropriate position. The bone pieces are then held in position with temporary pins or clamps, and the positioning is checked
with an X-ray. When the positioning is correct, your surgeon will fix the bone pieces together with plates and/or screws. The surgeon will confirm the final position of the bone, joints, and plates/screws on X-ray. The wounds are closed with layers of suture, and the foot is placed into a cast or splint
below the knee.
Depending on the severity of the fracture and other injuries, you may spend several days in the hospital or you may go home the same day. You should avoid putting weight on the leg until approved by your surgeon. If the fracture was sufficiently stabilized with the plates and screws, you may be placed into a removable boot once the incisions have healed. The boot will allow you to start moving the ankle to combat stiffness and to bathe.
For certain fractures, your surgeon may decide to place you in a new cast after the surgical dressings are removed. You typically will be on crutches and putting no weight on the injured foot for 8-12 weeks after surgery until X-rays show that the fracture
has healed sufficiently.
You can expect to have some degree of pain and stiffness after treatment. Many patients will require physical therapy. Complete recovery may take 6-12 months from the time of injury.
X-ray images of a talus fracture before surgery (above) and after surgery (below). For this patient, the surgeon used two screws to repair the fracture.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Immediate possible complications from talar surgery include wound healing problems, excess swelling, and infection. Patients typically receive intravenous antibiotics prior to surgery, but an infection still may develop in the days and weeks after surgery.
Most wounds will take about 2-4 weeks to heal safely, but this can take much longer if there were traumatic wounds, or if the patient has diabetes or smokes. In the hours to days after surgery, the foot may swell considerably after a talar fracture. If the swelling gets to be too much it may limit blood flow to the foot, resulting in a condition called compartment syndrome. There also is a chance that the bone cannot be put back to its original state, a complication called malunion. Any of these complications may require another procedure to correct.
Some of the most common long-term complications after talar fractures are arthritis and a condition called avascular necrosis (AVN) of the talus. Arthritis can occur after any injury to a joint surface and is more likely in a fracture that has shifted out of place. AVN, which is the death of bone tissue due to a lack of blood supply, also is more frequent with fractures
that have shifted.
Even if the bones heal well, the talus may develop arthritis at any of three joints: the ankle joint, the talonavicular joint, or the subtalar joint. The subtalar joint is directly below the ankle joint and is responsible for most of the side-to-side motion of our foot. Many patients experience some degree of pain, stiffness, and/or weakness after surgery.
If arthritis develops in one or more joints after a talus fracture, it can be treated with medication, braces, injections, and activity modification. If these treatments are unsuccessful, your foot and ankle orthopaedic surgeon may discuss additional surgery with you.
Avascular necrosis (AVN) of the talus can be a serious complication of talus fractures. AVN can occur with any injury depending on the severity of the fracture. If it does develop, it is not always painful. If it is painful then many of the same treatments for arthritis may be indicated, including additional surgery.
Yes. Smoking and any use of nicotine, including vaping, patches, and gum, affects your body’s ability to heal the broken bone as well as the surrounding tissues. Nicotine use also increases the risk of infection. You should entirely quit use of all nicotine immediately in order to minimize these risks.
No. If the hardware sets off the detection systems at the airport, you will receive further screening by TSA.
Original article by John Paul Elton, MD
Contributors/Reviewers: Sudheer Reddy, MD; Jeffrey Feinblatt, MD
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