A talus fracture is a break at one of the bones that forms the ankle joint. This sort of fracture often comes about within a high-energy event, such as a car collision or a high-velocity fall. Because the talus is essential for ankle movement, a fracture many times results in significant loss of movement and function. In addition, a talus fracture that does not heal properly can result in extreme complications, like chronic pain. As a result, many talus fractures call for surgery. Because of the obvious ramifications of the improper treatment of a talus fracture, Audrain Orthopaedics has released this important information for residents of Mexico, MO and the nearby Mid-MO area.
The talus is the bone that makes up the lower part of the ankle joint (the tibia and fibula bones of the lower leg constitute the upper part of the ankle joint). The talus sits over the heel bone (calcaneus). Combined, the talus and calcaneus form the subtalar joint, which is vital for walking, especially on uneven ground.
The talus is the main connector between the foot and leg, helping to transfer weight and pressure forces over the ankle joint. It is mainly covered by articular cartilage, the white slick material that covers all joint surfaces. This cartilage allows the talus to move properly against its neighbor bones.
Fractures take place in all parts of the talus bone. Most often, the talus breaks in its mid-portion, referred to as the "neck." The neck is between the "body" of the talus, found under the tibia, and the "head," located further down the foot.
Another common place for talus fractures is along the outside of the bone where it juts out a little. This region of the bone is known as the "lateral process." Fractures of the lateral process commonly occur whenever the ankle is forced out to the side and are typically observed in snowboarders.
Fractures are often classified in accordance with the severity of the displacement — exactly how much the pieces of bone have moved out of their normal position.
Minimally displaced or stable fractures: This kind of fracture is barely out of place. The broken ends of the bones line up almost correctly. In a minimally displaced fracture, the bones typically stay in place during healing, and surgery to fix the bones into position is not typically necessary.
Displaced fracture. When a bone breaks and the pieces move from their anatomic position, it's referred to as a displaced fracture. The amount of displacement pertains to the amount of energy that caused the fracture. Fractures which are highly displaced are more likely to be unstable. Unstable displaced fractures of the talus many times require surgery to restore correct alignment and to give the best opportunity for the return to normal movement of the foot and ankle.
Open fracture: Whenever broken bones break through the skin, they are known as open or compound fractures. Open fractures often involve far more damage to the surrounding muscles, tendons, and ligaments. In addition, open fractures expose the fracture site to the environment. They have a higher risk for complications and infection and take an extended period to heal.
Most talus fractures are the result of high-energy trauma such as a car collision or a fall from height. Injuries from sports, in particular from snowboarding, are another, less common, cause of talar injuries.
Patients with talus fractures typically experience:
- Intense pain
- Inability to walk or carry weight on the foot
- Significant swelling, bruising, and soreness
Most people with talus fractures ought to go to an urgent care center or emergency room for preliminary treatment because of the seriousness of their symptoms.
After going over your symptoms and medical history, your doctor will do a careful assessment. They will:
- Check out your foot and ankle carefully to determine if there are any cuts from the injury.
- Check to see if you are able to move your toes, and can sense things at the base of your foot. In some cases, nerves might be injured at the same time that the bone is broken.
- Examine your pulse at key points of the foot to make certain that there is good blood supply to the foot and toes.
- Check to see that pressure from fluids is not accumulating in the muscles of the foot, a disorder called compartment syndrome. Compartment syndrome can result in loss of sensation and function, and necessitates emergency surgery once it's diagnosed.
- Check if you have received any other injuries by checking out the rest of your injured foot and your legs, hips, and spine.
Information from diagnostic imaging tests will help your doctor determine whether surgery is required and is going to be critical for surgical planning.
X-rays. X-rays are the most widespread and widely available diagnostic imaging technique. An x-ray can show if the bone is broken and whether there's displacement (the gap in between broken bones). It can also show how many pieces of bone there are.
Central Missouri residents should know that speedy first aid treatment for a talus fracture, as with any painful ankle injury, is to employ a well-padded splint around the back of the foot and leg from the toe to the upper calf to restrict the limb and safeguard it. Elevating the foot over the level of the heart helps you to cut down on swelling and pain. Specific treatment is determined by the severity and the kind of fracture, so it is important to seek prompt medical attention.
Only fractures which are well-aligned (stable) are treatable with no surgery. This is very uncommon in a talus fracture, however, due to the high-energy force which causes the injury.
Casting. A cast will hold the bones in your foot in position while they heal. You'll have to wear a cast for six to eight weeks. During this time period, you'll be expected to restrict the amount of pressure you put on your foot. The idea is for the bone to heal adequately for you to bear weight on it without having the risk that it'll get out of place.
Rehabilitation. When the cast is removed, your physician will give you exercises to help you restore the range of motion and strengthen your foot and ankle.
If the bone tissues have shifted out of place (displaced), surgery to internally set and stabilize the broken pieces leads to the best result and reduces the threat of future complications.
Open reduction and internal fixation. During this operation, the bone fragments are first repositioned (reduced) to their normal alignment. They're then kept together with specialized screws or metal plates and screws.
Bones have an extraordinary ability to heal. The more serious your injury, however, the longer your recovery is likely to be. After surgery, your foot will be in a splint or cast from 2 to 8 weeks, dependent on the nature of the injury and how well the doctor thinks it is healing. As your bones start to heal, your doctor will more than likely order x-rays to make sure that everything is in alignment and healing correctly.
Following surgical treatment, you'll feel some discomfort. This is a natural part of the healing procedure. Your physician and nurses will work to lessen your pain, which makes it possible to recover from surgical treatment faster.
Medications are often prescribed for short-term pain relief after surgery. Various kinds of medicines are open to help manage pain, like opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your physician may use a mixture of these medicines to improve pain relief, plus minimize the need for opioids.
Bear in mind that though opioids help relieve pain after surgery, they are a narcotic and may be addictive. Opioid dependency and overdose has turned into a critical public health problem in the U.S. It is essential to use opioids only as advised by your doctor. As soon as your pain begins to improve, stop taking opioids. Speak with your doctor if your pain hasn't started to improve within a few days of your operation.
Lots of physicians encourage motion of the foot and ankle at the outset of the recovery period, once your pain permits. Patients that have had surgery are told to start moving the affected area once the wound heals. Patients who are treated without surgery will work on recovering motion in the foot and ankle after the cast is removed.
Specific physical therapy exercises can increase the range of motion in your foot and ankle, and strengthen supporting muscles.
When you start walking, you may have to utilize a cane and put on a special boot. You will not be able to put all of your weight on your foot for as much as two to three months. If you place too much weight on your foot too soon, the bone pieces might move out of place. Make sure to follow your surgeon's directions. As your break heals and your pain improves, you'll be permitted to put more pressure on your foot.
Avascular Necrosis (AVN)
With unstable talus fractures, the blood supply to the bone can be disrupted at the time of the injury. Sometimes, the blood supply just returns to the bone and normal healing starts. In other cases, however, the bone cells die without a blood supply, leading to a slow and quite painful collapse of the bone. This condition is referred to as avascular necrosis (AVN) or osteonecrosis with collapse.
When the bone collapses, the articular cartilage covering the bone tissue also collapses. Without this smooth cartilage, bone strokes on bone, leading to increased pain, arthritis, and loss of motion and function. The more serious the talus fracture, the more likely it is that AVN will develop. Even fractures that are treated properly, including those which are taken care of surgically, may develop AVN.
Posttraumatic arthritis is a form of arthritis that develops after an injury. Even when your bones heal normally, the cartilage shielding the bones can be damaged, leading to pain and stiffness over time. The majority of talus fractures result in some degree of posttraumatic arthritis. In cases of extreme arthritis that restricts activity, additional surgery, such as a joint fusion or ankle replacement, may be the best option to relieve symptoms.
For additional info on this pressing subject, please visit Dr. Weaver at Mexico, Missouri’s leading orthopaedic practice: Mexico Orthopaedics.