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TALAR DOME SKIN
TALAR DOME PLUS

There is another facet, medial to the above facets, for articulation with the spring ligament. There are anterior and middle facets that articulate with corresponding facets on the calcaneus. On its inferior aspect, this is continuous with three articular facets that are separated by smooth ridges. The talar head is the part that articulates with the navicular bone. The posterior aspect has a backward and medially facing posterior process, which has a lateral and medial tubercle separated by a groove for the tendon of flexor hallucis longus. The lower part of the lateral surface forms a bony projection called the lateral process which supports the lower portion of the lateral articular facet. The lateral articular surface is large and projects more inferiorly. The medial and lateral surfaces articulate with the medial malleolus (of the tibia) and lateral malleolus (of the fibula) respectively. The talar body has a curved smooth trochlear surface, also known as the talar dome, which is covered with hyaline cartilage and convex from front to back. Talus fractures in a four year old child BMJ Case Rep 2017 doi: 10.1136/bcr-2016-215063īyrne AM.The talus has been described as having three main components: head, neck, and body. Fractures of the Talus - Differences between Children and Adolescents. Pocketbook of Orthopaedics and Fractures. Complications of Talus Fractures in Children.

- Osteoarthritis of the tibiotalar or subtalar joint.

This is particularly common in displaced talar neck fractures, and is associated with significant disability.

- Avascular necrosis, due to the non-redundant blood supply of the talus.

This is a stricter regimen than in most ankle fractures.ġ2. What are the potential complications associated with this injury?

- The ankle will be immobilised and weight-bearing avoided until there is radiographic evidence of healing, due to the risk of avascular necrosis.

- Displaced injury: will need follow-up as arranged by orthopaedics.ġ1. What advice should I give to parents?.

- Nondisplaced injury: fracture clinic in one week with repeat X-Ray (AP, lateral and oblique).

(Return to weight bearing will be discussed by orthopaedics in the course of follow-up) Crutches or a wheelchair may be required to facilitate this.

- Displaced fractures should be referred to the nearest orthopaedics service.

If there is doubt about whether the fracture is truly non-displaced, a CT may be required.

- Truly undisplaced fractures can be placed in a below-knee cast with ankle at 90 degrees and seen in fracture clinic within a week.

These can have more displacement than is obvious on xray.ĩ. What is the usual ED management for this fracture?

- Any talar neck fracture should be referred to the orthopaedics service at the time.

Ideally this would take place in theatre if timely access is available.

TALAR DOME SKIN

- Type 3 and 4 talar neck fractures (displaced with posterior fragment extruded backwards) need urgent reduction as the skin is at risk of necrosis, and closed reduction often fails.If closed reduction is unsuccessful, open reduction internal fixation may be required. - Displaced talar neck fractures require reduction by orthopaedics.When is reduction (non-operative or operative) required? - MRI is sometimes used in diagnosis of a suspected osteochondral fractureħ.- CT may be required either for operative planning or to assess whether a fracture is truly non-displaced.- 3 plain-film views of the ankle: AP, lateral and oblique.- There may be co-existing fractures or injuries in high-force mechanismsĥ. What radiological investigations should be ordered?.- Findings may be minimal in a non-displaced or osteochondral fracture, especially in ankle inversion injuries.- Pain and swelling just distal to the anterior aspect of the ankle.

TALAR DOME PLUS

- Fractures of Talar neck and body occur with combination of dorsiflexion plus axial loading: eg falling from a height in crouching position or collision of go-cart with foot on brake pedal.- Uncommon injury, particularly in children.How common are they and how do they occur Hawkins Classification of Talar Neck fractures:ģ. - Displacement (Including presence of absence of subtalar subluxation.- Anatomical Location: Neck, Body, Lateral Process, or osteochondral fracture of the dome.This risk can be attenuated by appropriate early diagnosis and management. Talus fractures are uncommon injuries in children but are frequently associated with significant long-term disability due to the risk of avascular necrosis or osteoarthritis.