Summary
Displaced talar neck fractures are very serious injuries. This type of fracture occurs when there is a significant amount of force applied to the sole of the foot forcing the foot to flex upwards (dorsiflex) and thereby driving the talar neck up against the front of the ankle joint. Talar neck fractures usually occur form high energy njuries such as a motor vehicle accidents where the foot is driven into the floorboard, or by falling from a substantial height. As the foot is driven forward, the talar neck is forced onto the front of the ankle creating the fracture. Historically, this injury has been called “aviator’s astralgus” (astralgus is a word meaning talus) because when pilots in World War I would crash their planes, their foot would often be driven up into the floorboards leading to a talar neck fracture.
In some instances the force can be great enough to dislocate the talar body (the back part of the talus after the fracture) out of the ankle joint posterior (behind the ankle joint). It is also possible that the bone may actually break through the skin at the time of the injury, creating an open fracture. Symptoms of a talar neck fracture include marked pain, swelling, and the inability to bear any significant weight. Often the prognosis for full recovery from talar neck fractures is guarded.
Physical Examination
Patients will have swelling, localized discomfort around the ankle joint, and may or may not have a nerve injury. The foot may appear deformed in an angulated or twisted manner.
Imaging Studies
A talar neck fracture can be diagnosed via x-rays of the foot, where will be seen going through the talar neck region. Rarely, but occasionally, the fracture is undiplaced and can be difficult to read on plain x-ray. To more easily understand fracture pattern and particularly if surgery is a possibility, a CT scan will be ordered.
Treatment
Treatment of displaced talar neck fractures is operative (talar neck ORIF). The goal of surgery is to return the talus to its original position prior to the fracture. Although this procedure may be challenging, it is very critical to get an anatomical reduction in order to avoid malalignment of the foot.
Edited August 11th 2009
