Talar Body Fractures Research Articles

Atypical lesional association (Talus Fracture + Pilon Fracture): A case report

Background: Talus fractures represent 3% to 6% of all foot and ankle fractures and are frequently associated with significant morbidity and poor outcomes. They typically result from high-energy trauma, such as motor vehicle accidents or falls from heights. The combination of talar body and tibial plafond fractures is particularly rare, with few cases reported in the literature. Case Report: We present the case of a 20-year-old female who sustained a closed injury to her right ankle after a 6-meter fall. Clinical examination revealed swelling, pain, and bruising without skin opening or neurovascular disturbances. Radiographs and a CT scan identified a non-displaced fracture of the tibial plafond, a medial malleolus fracture, and a posterior process talus fracture. The patient underwent closed reduction and internal fixation with percutaneous screws. At six months post-surgery, she exhibited a good functional outcome with minimal residual pain and slight limitations in ankle movement. Discussion: Talar body fractures commonly result from falls that exert axial compression or shearing forces. Severe cases involve comminution of the ankle and subtalar joints, often accompanied by malleoli fractures. The concomitant fracture of the tibial plafond and talus, as seen in this case, is rare. Managing such injuries is challenging due to high risks of avascular necrosis, subtalar arthritis, and restricted ankle motion. Thorough radiographic and clinical assessments are crucial for effective management, emphasizing the need for careful preoperative planning, precise anatomical reduction, and stable fixation. Conclusion: This rare case of combined talus body and tibial plafond fractures highlights the importance of comprehensive evaluation and appropriate management to minimize serious complications.

LATERAL TRANSLIGAMENTOUS APPROACH TO THE TALAR DOME

IntroductionAnatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated a maximum of 25% talar body exposure without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach.MethodsThe lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach, following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion.The talus was disarticulated and high resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid with a perpendicular surgical blade was documented. ImageJ software was used to calculate the surface area exposed with each approach.ResultsThe mean percentage area of talar dome available through the transligamentous approach was 77.3 % (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1,2, 3,5 & 6 with partial access to Zones 4,8 & 9.ConclusionThe lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zone 4 and Zone 7, the posteromedial corner.

Treatment of Complex Central Talar Fractures with Lateral Plate Combination with Medial Screw Fixation.

The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures. The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system. The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%). The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon's thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.

THE ARTHROSCOPIC MANAGEMENT OF TALAR BODY FRACTURES

Talar body fractures are high energy intraarticular injuries that are best management by anatomical reduction and secure fixation to improve outcomes. The talus is relatively inaccessible surgically and requires extensive soft tissue dissection and/or osteotomies to gain adequate open visualisation. There are a small number of case reports on arthroscopic assisted fixation in the literature. This case series reports on the technique and early outcomes of six patients all of whom presented with significant intraarticular displacement and who were managed entirely arthroscopically.The fractures were of the main body of the talus involving the ankle and subtalar joints and all had preoperative CT scans. All six patients underwent posterior ankle and subtalar arthroscopy with cannulated screws used to stabilise the fractures after reduction. Visualisation of the fracture reduction was excellent. After 10 days in a backslab, the patients were protected in a boot and encouraged to actively move their ankles. Weight bearing was permitted once union appeared complete.There were no early complications of infection, avascular necrosis or VTE. There was one patient that had a non-clinically significant migration of a screw. Two patients were lost to follow up early due to being visitors. The mean length of follow up was 12 months in the remainder. The remaining four patients all returned to their preoperative level of activity. All had demonstrable subtalar stiffness. There was no early post-traumatic arthritis.This series represents the largest so far published. The main flaw in this report is the lack of long term follow up. While this report cannot state superiority over open techniques it is a safe, effective and acceptable technique that has significant conceptual benefits.

Infection Rates and Surgical Procedures Associated With Isolated Open Talar Neck and Body Fractures.

Open fractures of the talar body and neck are uncommon. Previous reports of associated deep infection rates and resulting surgical requirements vary widely. The primary objective of this study is to report the incidence of deep infections for isolated open talar body and neck fractures, and secondarily the incidence and number of total surgeries performed (TSP), secondary salvage procedures (SSPs), and nonsalvage procedures (NSPs). Retrospective case-control study of 32 consecutive isolated open talus fracture patients (22 neck, 10 body) were followed for an average of 39.2 months. Five (15.6%) fractures developed deep infections. Fifty percent of open body fractures became infected compared with 0% of neck fractures (P < .001). There was no difference between infected group (IG) and uninfected fracture group (UG) with respect to age, sex, body mass index, tobacco, diabetes, vascular disease, open fracture type, wound location, hours to irrigation and debridement, or definitive treatment. The majority (92.6%) of UG fractures used a dual incision with open wound extension. There were more single extensile approaches in the IG group (P = .04). The IG required 5.8 TSP per patient compared with 2.1 in the UG (P = .004). All (100%) of the IG required an SSP compared with 29.6% of the UG (P = .006). All (100%) of the IG required an NSP compared to 40.7% of the UG (P = .043). In the IG, 2.8 NSPs per patient were required after definitive surgery compared with 1.18 in the UG (P = .003). Of those followed 1 year, the incidence of SSP remained higher in the IG (P = .016). The incidence of deep infection following isolated open talar fractures is high and occurs disproportionally in body fractures. Infected fractures required nearly 6 surgeries, and all required SSP. Level IV, prognostic.

Identifying risk factors for osteonecrosis after talar fracture.

To identify patient, injury, and treatment factors associated with development of avascular necrosis (AVN)following talar fractures, with particular interest in modifiable factors. Retrospective chart review. 21 US trauma centers and 1 UK trauma center. 2,220 patients with talar neck and/or body fractures. Open reduction internal fixation of talar neck and body fractures. Development of AVN. Infection, nonunion, and arthritis were secondary outcomes. 796 patients (408 M; 388 F; age 18-81, avg 38.6) with 796 (532R; 264L) fractures were included and were classified as Hawkins 1(51), IIA(71), IIB(113), III(158), IV(40), neck plus body (177), body (188). 336/798 developed AVN (42%), more commonly following any neck fracture (47.0%) vs isolated body fracture (26.1%, p<0.001). More severe Hawkins' classification, combined neck and body fractures, body mass index (BMI), tobacco smoking, right-sided fractures, open fracture, dual anteromedial and anterolateral surgical approaches, and associated medial malleolus fracture were associated with AVN. After multivariate regression, fracture type, tobacco smoking, open fractures, dual approaches, age, and BMI remained significant.Excluding late cases (>7 days), time to joint reduction for Hawkins type IIB-IV neck injuries was no different for those who developed AVN or not. AVN rates for reduction of dislocations within 6 hours of injury vs >6 hours were 48.8% and 57.5%, respectively. Complications included 60 (7.5%) infections and 70 (8.8%) nonunions. 42% of all patients developed AVN, with talar neck fractures, more displaced fractures and open injuries having higher rates. Injury-related factors are most prognostic of AVN risk. Surgical technique to emphasize anatomical reduction, without iatrogenic damage to remaining blood supply is essential. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Isolated, displaced, talar body fracture: a case report and literature review.

Talar body fractures are uncommon fractures of the foot and its management results to be very hard due to retrograde vascularization and wide articular cartilage coverage of talar surface, which could easily lead to poor functional outcomes, avascular osteonecrosis and early post traumatic arthritis. We describe a case of displaced, vertical, talar body fracture in a 41-year-old patient treated with reduction and fixation by talar anteromedial approach coupled to medial malleolar osteotomy to better expose the fracture. Our literature review has found few studies, in addition with a low level of statistical evidence. We advocate for more studies with a bigger sample and with a design of randomized control trials.

Coronal Shearing Fracture of the Talar Body with Talar Head Dislocation Related to a Navicular Compression Fracture: A Rare Case Report.

A talar body fracture is typically associated with talar body dislocation, resulting in ankle and subtalar joint subluxation and/or dislocation. A talar body fracture with talar head dislocation is a very rare injury. In this report, we describe the case of a 23-year-old man who suffered a coronal shearing fracture of the talar body with talar head dislocation related to a navicular compression fracture. The patient sought orthopedic consultation 6 weeks after injury. The injury was managed with open reduction, talar head relocation, internal fixation of the talar body fracture with Kirschner wires and cancellous screws and talonavicular fusion with an iliac bone autograft. Follow-up 4 years after operative treatment showed that the patient had satisfactory treatment results, including good bone healing with minimal changes in the anterior talotibial compartment and excellent function of the hindfoot and ankle.

Open Fracture-Dislocation of the Talar Body Concomitant with the Anterior Talofibular Ligament Rupture: A Case Report and Literature Review

Background: The talus bone is the second-largest bone in the tarsal region. Talar fractures are rare injuries that occur due to highenergy traumas. Open reduction and internal fixation (ORIF) is the treatment of choice in the talar body fracture-dislocation. Avascular necrosis (AVN), osteoarthritis (OA), malunion, non-union, skin infections, and ankylosis of the subtalar joint are complications that can happen following the talar body fracture.&#x0D; Case Report: We reported a rare open fracture-dislocation of the talar body concomitant with the anterior talofibular ligament (ATFL) rupture in a 24-year-old motorcyclist man. ORIF with two 4.5 mm cancellous screws and ATFL repair were performed. After 6 months of follow-up, the radiographic bone union was achieved, and the patient had no complaints of pain, disability, and discomfort.&#x0D; Conclusion: According to the blood supply of the talus bone, appropriate management and follow-up should be considered to prevent severe consequences. Due to the lack of literature on this lesion, in this report, we tried to provide more comprehensive information regarding the diagnosis, treatment, and follow-up of this group of patients. To the best of our knowledge, our case will probably be the second case of the talar body fracture concomitant with rupture of the ATFL.

Talar body and posterior talar process fracture combined with peritalar luxation (clinical case)

The uniqueness of this clinical case is due to a rare combination of peritalar luxation of the talus with a fracture of its body and posterior process. No description of the same clinical case was found in the literature, however, it has been proven that such injuries have an unfavorable prognosis and are fraught with multiple complications. Also, the limited information associated with the low incidence of this type of severe injury puts practitioners in front of the difficulties of diagnosis and treatment. A 35-year-old man was injured while playing basketball. Upon admission, computed tomography (CT) revealed a fracture of the body of the talus with displacement of the distal fragment and its dislocation in the talonavicular, subtalar and talo-tibial joints, as well as a fracture of the posterior process of the talus. After an unsuccessful attempt at closed reduction, open removal of the dislocation and reposition of fragments were performed, followed by osteosynthesis of the fracture of the body of the talus. In the postoperative period, additional immobilization in the ANF was performed, followed by replacement with a functional orthosis. 6 months after the injury, the patient restored the level of his daily activities almost completely, the control CT showed no signs of post-traumatic arthrosis of the subtalar and ankle joints, how-ever, there were signs of the development of partial aseptic necrosis of the talus. This injury is unique, and despite its severity, the use of the correct treatment tactics can provide a satisfactory clinical and functional outcome.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Complications after talus fractures: A trauma centre experience

BackgroundTalus fractures are anatomically complex, high-energy injuries that can be associated with poor outcomes and high complication rates. Complications include non-union, avascular necrosis (AVN) and post-traumatic osteoarthritis (OA). The aim of this study was to analyse the outcomes of these injuries in a large series. MethodsWe retrospectively collected data on 100 consecutive patients presenting to a single high volume major trauma centre with a talus fracture between March 2012 and March 2020. All patients were over the age of 18 with a minimum of 12 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded. ResultsThe mean age was 35 years (range: 18–76 years). Open injuries accounted for 22% of patients. An isolated talar body fracture was the most frequent fracture (47%), followed by neck fractures (20%). The overall non-union rate was 2% with both cases occurring in patients with open fractures. The AVN rate was 6%, with the highest prevalence in talar neck fractures. Overall rates of post-traumatic OA of the tibio-talar, sub-talar and talo-navicular joints were 12%, 8%, and 6%, respectively. These were higher after a joint dislocation, and higher in neck or head fractures. The postoperative infection rate was 6%. The overall secondary surgery rate was 9%. There were 2% of patients who subsequently underwent a joint arthrodesis. ConclusionOur study found that talar body fractures are more common than previously reported; however, talar neck fractures cause the highest rates of AVN and post-traumatic arthritis. Open fractures also carry a greater risk of complications. This information is useful during consenting and preoperatively when planning these cases to ensure adverse outcomes may be anticipated.

Effect of percutaneous and arthroscopically assisted osteosynthesis of talar body fractures

BackgroundTalar fractures are relatively uncommon, and the complex anatomy of the talus impedes their visualization, reduction, and fixation without performing an arthrotomy or osteotomy. To date, few studies have evaluated the complications of arthroscopically assisted percutaneous talar osteosynthesis. This clinical retrospective study aimed to investigate the effectiveness of this procedure according to the complications and functional outcomes.MethodsArthroscopically assisted percutaneous talar osteosynthesis was performed in 15 patients (10 men and 5 women) with 16 fractures (one bilateral). The mean patient age was 31 years (range, 14–52 years). The Sneppen classification of the fractures was type II in 14 cases and type III in 2 cases.ResultsFifteen patients were followed up for 36 months on average (range, 18–65 months). No skin infection, osteomyelitis, or skin necrosis was observed in any patient. During the follow-up, no bony non-union or delayed union was found. At the final follow-up, 2 out of the 15 patients (13.3%) had peri-talar osteoarthritis. The ankle–hindfoot pain was absent in 11 patients (12 ankles) and mild in 4 patients. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot scale, functional results were excellent in 7 ankles and good in 9 ankles. The mean AOFAS ankle–hindoot score of the patients was 85.7 (range, 79–93).ConclusionArthroscopically assisted percutaneous talar osteosynthesis is a reliable and feasible technique that yields good clinical outcomes.

Dual Approach to Talar Body Fractures Increases Talar Dome Access for Fracture Care without Osteotomy

Category: Trauma; Ankle; Hindfoot Introduction/Purpose: No consensus surgical treatment algorithm exists for talar body fractures, with authors recommending both soft-tissue and osteotomy-based approaches. This study evaluated the utility of dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches, both with and without distraction. Methods: Ten cadaveric legs (5 matched pairs) were included. A mPM approach, between FHL and Achilles tendon, and an ATL approach, utilizing an anterolateral incision with transection of the ATFL and CFL fibular insertions, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4mm of tibiotalar distraction. Specimens were analyzed by micro-computed tomography. Primary outcome was total accessible DSA. Student's t-tests compared DSA accessed by different exposure methods. Results: An initial mPM approach allowed access to 25.6% and 33.6% of DSA without and with distraction (p=0.002). An initial ATL approach provided access to 47.0% and 58.1% of DSA without and with distraction, respectively (p=0.003). No significant difference in DSA accessibility were observed for either approach when they were performed second. Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (p=0.96 and 0.37, respectively). (Figure 1) Conclusion: Dual approaches provided access to greater than 70% and 85% of DSA without and with distraction. Order of approach did not change access. These results may promote soft-tissue only treatment strategies in talar body fracture care.

Dual Approach to Talar Dome Increases Access for Fracture Care Without Osteotomy.

There is no consensus surgical treatment algorithm for talar body fractures, with authors recommending both soft tissue-only and osteotomy-based approaches. This study evaluates talar dome access via dual approaches to the talar dome through anterolateral transligamentous (ATL) and modified posteromedial (mPM) approaches. Ten cadaveric legs (5 matched pairs) were included. An mPM approach, between flexor hallucis longus and Achilles tendon, and an ATL approach, utilizing the anterolateral interval with transection of anterior talofibular ligament and calcaneofibular ligament, were performed on each specimen. Order of approach was alternated within each pair. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire at the visualized talar dome margin both with and without 4 mm of tibiotalar distraction using an external fixator. Specimens were analyzed by computed tomography (CT). Primary outcome was accessible DSA. Student t tests compared DSA accessed by different exposure methods. An initial mPM approach exposed 25.6% and 33.6% of DSA without and with distraction (P = .002). An initial ATL approach accessed 47.0% and 58.1% of DSA without and with distraction, respectively (P = .003). Accessibility via dual approaches was 71.7% and 93% of DSA without and with distraction with an initial ATL approach and 71.3% and 87.5% of DSA without and with distraction with an initial mPM approach (P = .96 and .37, respectively). The central talar dome was inaccessible in an almond-shaped area, tapered at the medial and lateral ends. Anterior, lateral, and posterior articular margins were able to be fully exposed, often with overlapping exposure between posterior and anterior approaches, with distraction reliably improving lateral visualization. Dual approaches provided access to greater than 70% and 85% of talar DSA without and with distraction, respectively. Order of approach did not significantly affect exposure and thus should be determined by surgeon discretion. These results may promote soft tissue-only treatment strategies in talar body fracture care with an extensile exposure of the talar dome surface. Careful preoperative planning optimizes the advantages of this approach. Level IV, case series.

388 Patient-Specific 3D Printed Talus Truss Cage with Hindfoot Nail Arthrodesis – a Novel Salvage Procedure for Complex Post-Traumatic Talus Avascular Necrosis

Abstract Background Post-traumatic avascular necrosis (AVN) following talus fracture can be a devastating injury, with subsequent destruction of the tibio-talar-calcaneal articulations resulting in joint degeneration and compromised mobility. Tibio-talar-calcaneal arthrodesis is a salvage procedure where large bone voids can present significant challenges. Whilst a range of arthrodesis techniques have been described, we present a unique case of patient specific 3D-printed talus truss cage with navicular articulation and hindfoot nail fusion. Case Presentation We present a case of an 80-year-old fit and well gentleman who was a delayed presentation with a Hawkins 3 talar neck fracture and a Mueller AO / OTA C3 talar body fracture. The patient opted for a trial of conservative management over primary fusion, but at 3 months post-injury there was talar body collapse and progression of subtalar degeneration, therefore he underwent talus fixation with subtalar fusion. At 6 months post-injury, there was collapse of the tibio-talar joint with AVN of the talus. The patient had ongoing discomfort and a decision was made to proceed with custom implant arthrodesis. At 7 weeks post-operatively the patient's wounds have healed without complication and talus height is maintained. Follow-up is ongoing. Discussion The mainstay of treatment for severe post-traumatic talar AVN has been arthrodesis of the hindfoot and ankle with complication rates as high as sixty percent, including mal-union and loss of bone height. This case highlights the potential of a patient specific 3D-printed talus truss cage to manage complex bone defects and these challenges of arthrodesis.

Posteromedial Talar Body Fracture: Case Discussion and Surgical Technique

Posteromedial talar body fractures are a rare form of talus fracture that involves the tibiotalar and subtalar joints. In cases of displaced injuries, open reduction and internal fixation is typically recommended to minimize the risk of instability and post-traumatic osteoarthritis. This video presents a case of a posteromedial talar body fracture and highlights the technique for operative fixation through a posteromedial approach. Multiple methods to obtain reduction are discussed, and considerations with implant placement are described. The indications for surgical intervention are reviewed, and published outcomes following operative and nonoperative management of these injuries are presented.

Clinical and radiological outcomes of internal fixation of complex talar neck and body fractures with locking plates through a dual approach

IntroductionTalar fractures are rare and surgical treatment has not been standardized. The literature is rather poor on preserving talar vascularization in single or dual approaches. A dual approach allows better exposure and should limit devascularization. Locking plates are one of the modern solutions for challenging comminuted fractures. The aim of this study was to determine clinical and radiological outcomes in complex talar fracture (CTF) of the neck and body, fixed by locking plates through a dual approach with at least one locking plate. HypothesisLocking-plate fixation of CTF through a dual approach leads to good clinical outcome. Material and methodsA single-center retrospective study included 12 cases of CTF treated between January 2007 and May 2019. 3D CT was systematically performed to plan surgery. A dual approach and at least one locking plate were used for fixation. Clinical outcome was evaluated on AOFAS score. Reduction quality and correlation to clinical results were evaluated, reduction with<2mm joint step being considered satisfactory. Consolidation rate and occurrence of avascular necrosis of the talus (ANT), post-traumatic arthritis (PTA) and postoperative complications were analyzed. ResultsMean follow-up was 27 months (range, 15–47). Mean AOFAS score was 70±18 (range, 30–97). Inframillimetric reduction was achieved in 67% of cases, without significant correlation with clinical results. The consolidation rate was 91.6%, ANT rate 18.2% and PTA rate 45.5%. One patient presented septic osteoarthritis secondary to scar necrosis. ConclusionLocking plate fixation of CTF through a dual approach provided acceptable clinical outcomes. Level of evidenceIV; retrospective study.

Complications and Functional Outcome Following Operative Treatment of Talus Neck and Body Fractures: A Systematic Review.

Background:Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures, complications rates remain high and functional outcome is generally poor. This study aims to provide an overview of complication rates and functional outcome following operative treatment of talar neck and body fractures. This may help in clinical decision making by improving patients’ expectation management and tailored treatment strategies.Methods:A systematic review of the literature was conducted of studies published from January 2000 to July 2021 reporting functional outcome and/or complications following operative treatment of talar neck, body, or combined neck and body fractures. Keywords used were (Talar fracture) or (Talus fracture). Data on complication rates and functional outcome was extracted from selected articles.Results:A total of 28 articles were included in our analysis reporting 1086 operative treated talar fractures (755 neck [70%], 227 body fractures [21%], and 104 combined body and neck fractures [9%]). The mean follow-up was 48 (range 4-192) months. Complications occurred frequently with; 6% surgical site infection, 8% nonunion, 29% avascular necrosis, 64% osteoarthritis, and in 16% a secondary arthrodesis was necessary. A wide variety in functional outcome was reported; however, there seems to be a correlation between fracture classification and postoperative complications.Conclusion:Operative treatment of central talar fractures is associated with a high incidence of early and late complications and often leads to an impaired functional outcome. Standardization of talar fracture classification and scoring systems in combination with large sample-sized prospective studies are warranted to detect further predictive factors influencing tailormade treatment strategies and patient expectation management.Level of Evidence:Level III, Systematic review of case series and case-control studies.

Talus Fractures in Snowboarders: A Case Series

Fractures of the lateral process of the talus have been associated with snowboarding, so much so that they have earned the nickname “snowboarder’s ankle”; these typically occur with relatively low-energy injuries when compared with fractures of the talar head, neck, and body. We have observed that snowboarding portends a higher risk of talus fractures when compared with skiing and can include higher energy injury patterns. This study describes a series of talar head, neck, and body fractures caused by snowboarding, their treatment, and outcomes. A retrospective chart review was performed on all surgical cases collected from 2007 to 2012 to include talar head, neck, body, or lateral process fractures sustained while snowboarding. Radiographs were reviewed and the fractures were characterized. Questionnaires, including the Foot and Ankle Disability Index (FADI), were mailed to the patients. The pre-operative reports, surgical treatments, and outcomes were evaluated. Nine patients were identified with fractures of the talus caused by a snowboarding injury. One patient sustained an isolated talar head fracture, three sustained isolated talar neck fractures, one patient had an isolated talar body fracture, and two patients had isolated lateral process fractures. Two patients had a combination of talar injuries. At 2.5 years mean follow-up (range 6 months to 5 years), none of the patients developed avascular necrosis, nonunion/malunion, or required subsequent surgery. FADI scores indicated good to excellent results post-operatively.