TALAR BODY FRACTURES

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Fractures of the body of the talus include a variety of injuries, ranging from minor to devastating in nature. Sneppen and Buhl16 classified them into five types: transchondral and osteochondral fractures (includes osteochondritis desiccans); coronal, sagittal, or horizontal shear fractures (whole-body fractures); posterior tubercle fractures (shepherd's fractures); lateral process fractures; and crush fractures of the whole body. The talar body is an integral component of the ankle and subtalar joints, and all fractures of the body require anatomic reduction and usually undergo internal fixation for definitive treatment. Because of the wide disparity of treatment and prognosis for these different fractures, each is discussed separately.

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OSTEOCHONDRAL FRACTURES OF THE TALAR DOME

The term osteochondral fracture suggests an acute mechanism of injury. Most osteochondral fractures of the dome of the talus occur in two distinct locations—anterolateral and posteromedial. Anterolateral injuries generally are associated with trauma; posteromedial lesions can occur with acute trauma, although they frequently are believed to be nontraumatic or due to cumulative trauma.3, 14

In a classic article, Berndt and Harty2 noted that 88% of patients with osteochondral lesions had a history

SHEAR FRACTURES OF THE TALAR BODY

Shear fractures of the body of the talus are subdivided into coronal, sagittal, and horizontal fractures. These fractures are uncommon and occur frequently in combination. A shear fracture to the body of the talus is defined as one that has its dorsal fracture line extending into the articular surface of the dome of the talus. A coronal fracture is essentially a more posterior location of a talar neck fracture. Most series describing these fractures are small, but it is accepted that the

FRACTURES OF THE POSTERIOR TUBEROSITY

Fractures of the posterior tuberosity of the talus usually involve the more prominent posterolateral tubercle, which provides an insertion for the posterior talofibular ligament. Its inferior surface is in continuity with the posterior facet of the talus. The os trigonum, an accessory bone, frequently is found in association with the posterolateral tubercle. It is believed to arise from a failure of fusion of a secondary center of ossification.

The posterior tuberosity can be fractured by two

FRACTURES OF THE LATERAL PROCESS OF THE TALUS

Fractures of the lateral process of the talus account for approximately one fourth of all fractures of the body of the talus.4 The fracture involves the lateral process of the talus and involves the talofibular articulation of the ankle joint and posterior facet of the subtalar joint. The lateral talocalcaneal, cervical, bifurcate, and anterior talofibular ligaments have attachments to this process. The usual mechanism of injury is acute dorsiflexion and inversion of the foot. The injury

COMMINUTED BODY FRACTURES

Comminuted body fractures have the worst prognosis of all talar body injuries. They generally are due to high-energy injuries and frequently are open injuries. Their treatment is the same as that for the shear-type fractures; however bone loss frequently is encountered during the operative reduction, leading to nonanatomic reduction and a high incidence of avascular necrosis of the various segments. These injuries are extremely rare. In the author's experience, the results are uniformly poor in

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Address reprint requests to David B. Thordarson, MD, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 2025 Zonal Avenue, GNH 3900, Los Angeles, CA 90033, e-mail: [email protected]

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Divisions of Foot and Ankle Trauma and Reconstructive Surgery, Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California

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