What Is A Talus Fracture

Overview

If you have ever experienced pain in your ankle, to such an extent that you could not bear any weight on it, most likely you sprained your ankle. But now and then it can turn out to be a fracture in one of the bones of your ankle (broken bone).

The bone in your foot that joins your ankle to your leg is called the talus. A break in this bone is called a talus fracture. Your ankle joint is formed by the union of your talus with your lower leg bones, fibula and tibia. Your foot may move up and down thanks to this joint. Your joint below the talus is formed by your talus sitting above your calcaneus, the heel bone. Your foot's ability to move from side to side is made possible by this joint.

Weight is transferred over the ankle joint by your talus. The majority of it is cartilage-covered. Because cartilage is slick, your bones may move in unison against one another. The talus is crucial for ankle mobility, therefore a fracture can result in a major loss of function and range of motion.

A simple slip or tumble might result in twisting damage to your ankle, while immediate trauma from a fall or impact to the ankle can shatter one or more of these bones. A break in the knobby bumps at the end of the tibia and fibula might result from rolling your ankle.

Ankle fractures can range in severity. Small fissures in your bones, to breaks that puncture your skin can all be considered fractures.

The precise location and extent of the bone fracture will determine how to treat a fractured ankle. To maintain an appropriate position during the healing process, a badly fractured ankle may need surgery to insert plates, rods, or screws into the damaged bone.

In this article, we present information regarding what to expect in a fracture of this sort and when to go see a doctor, so that you can get the right help at the right time.^1,2

Anatomy of the talus bone

The tibia and fibula comprise the top portion of the ankle joint, while the talus makes up the bottom portion. You can shift your foot up and down thanks to the ankle joint. Moreover, the talus rests atop the calcaneus, the heel bone. When walking over uneven terrain, the ability of your foot to move inward and outward through this joint is crucial.

The primary joint that connects the foot to the leg, the talus, aids in the distribution of pressure and weight across the ankle joint. Articular cartilage, the white, slick substance covering every joint surface, covers most of it. The talus may glide easily against its neighbouring bones because of its cartilage.²

Types of talus fractures 

There are several locations and methods in which your talus bone may fracture. Fractures of the talus bone include:^1,3,4

• Neck: The midsection of your talus is where the most  talar fractures happen. We refer to this as the neck. The neck is situated between the "head" of your talus, located farther down your foot, and the "body" of your talus, which lies under your tibia near your ankle joint.

• Lateral process: The term "lateral process" refers to the outside portion of your talus bone. Your ankle can fracture in this way if it is thrust out to the side. Sometimes referred to as "snowboarder fractures," as lateral process talus fractures are frequently observed in snowboarders.
• Avulsion fractures: When a little portion of your talus bone rips apart from the rest of the bone at the location where it is connected to a ligament or tendon, you may have a talar avulsion fracture.
• Stress fractures: A little split in your talus bone is called a talar stress fracture. Overuse or repetitive stress on the talus bone might result in this kind of fracture.

Causes and risk factors

Although a direct hit to the ankle can sometimes result in a broken ankle, twisting injuries are the most common cause.^1,2

The following are the most typical reasons for a fractured ankle:

• Vehicle mishaps: Crushing injuries sustained in car accidents might result in breaks that need to be surgically repaired.
• Falls: Ankle fractures can occur by tripping and falling or from landing on your feet after jumping down from a height.
• Slipups: Occasionally, merely placing your foot incorrectly might lead to a twisting injury that may break your bone.

In terms of risk, an increased risk would be found in, although less prevalent, sports-related injuries, especially while snowboarding, which can also result in talus injuries.

Signs and symptoms

A talus fracture is most frequently characterized by excruciating ankle pain and oedema. Some signs and symptoms might be:¹

• Having trouble walking
• Unable to support your weight with your foot
• Bruising
• Tenderness
• Blisters that burst, leaving fluid-filled lesions on the skin

Diagnosis

Because the symptoms are so severe, most people with talus fractures will first visit an emergency hospital or urgent care facility.^1,2

Physical assessment

Once your doctor has reviewed your medical history and symptoms, a thorough examination will be performed. While taking the test, he or she will

• Take a close look at your ankle and foot to check for any wounds from the trauma
• Verify if you can move your toes and sense objects with your feet. In rare instances, nerve damage may occur along with a shattered bone
• To make sure there is adequate blood flow to your foot and toes, check your pulse in your foot
• Make sure there is no accumulation of fluid pressure in the leg muscles, which might lead to compartment syndrome. Once diagnosed, compartment syndrome necessitates immediate surgery and can cause loss of function and feeling
• Examine the remainder of your damaged foot, your legs, your pelvis, and your spine to see whether you have any further injuries

Imaging exams

Your doctor will use the results of diagnostic imaging tests to determine whether surgery is necessary, and these tests will provide important information for surgical planning.^2,3

• X-rays: The most popular and accessible diagnostic imaging method is X-rays. An X-ray can reveal whether there is displacement (fragments out of position) and whether the bone is shattered. It can also demonstrate the quantity of bone fragments.

• CT scan (computerized tomography): Your doctor may also prescribe a CT scan if, after reviewing your x-rays, if they still require further information. Your foot's cross-section is seen on a CT scan. In addition to making the fracture lines easier for your doctor to view, it can give important information on how severe the fracture is.

Treatment options 

The kind of fracture and the extent of the damage will determine how you are treated for a talus fracture. Initially, a splint will be used to immobilise your ankle and foot. Surgery might not be required if your fracture is stable and your joints are in good alignment. Your medical professional could advise:

Casting: Your foot and ankle bones are held together as they mend by a cast. You will usually need to keep the cast on for six to eight weeks while applying very little pressure to your foot.

You will be taught exercises to help recover your foot and ankle's strength and function when the cast is taken off.

Ankle surgery is usually advised for talus fractures due to the high-energy force. A foot and ankle surgeon will undertake surgery to realign your misaligned bones.

An open reduction and internal fixation (ORIF) may be performed by your surgeon if your bone is fractured into many fragments. Your broken bones are reattached using an ORIF and secured with screws, a metal plate, or both until the bone heals.

If your oedema is excessive, your surgeon could put you in an external fixator. Your surgeon will insert big pins into your bones to stabilise them using an external fixator. The pins hold your skin together and are visible from the outside. Once the swelling subsides, your surgeon could attempt an ORIF once more.^1,3

Recovery and rehabilitation

Bones can repair themselves astonishingly well. The more serious your injury, the longer it can take to heal. Your foot will be in a cast or splint for two to eight weeks following surgery. This depends on the type of injury sustained and the rate at which it heals. To make sure the bones mend correctly and remain in their appropriate place, your doctor will take X-rays. They will also assign you to a regimen of medication and rehabilitation, as mentioned below:^1,5

Pain management: Following surgery, there will be some discomfort. This is a normal stage of the recovery process. Your surgeon and nursing staff will try to lessen your discomfort so you can heal from surgery more quickly.

Following surgery, medications are frequently provided for temporary pain management. Many different kinds of medications may be used to treat pain, such as local anaesthetics, NSAIDs, and opioids. To reduce the need for opioids and enhance pain relief, your doctor may combine these drugs.

Though they can aid with post-operative pain relief, opioids are narcotics and can become addictive. World over, opioid addiction and overdose have emerged as serious public health concerns. Therefore, It is crucial to take opioids exactly as prescribed by your physician. Put an end to your opioid use as soon as your pain starts to subside. If, after a few days following your operation, your discomfort has not started to subside, consult your doctor.

Physical therapy: As soon as your pain permits and early in the healing phase, many specialists advise moving your ankles and feet. Following surgery, patients are advised to start moving the impacted region as soon as the incision heals. After the cast is taken off, patients receiving non-surgical treatment will focus on restoring movement in their ankles and feet. Thus doctors will advise taking physical therapy sessions to speed up the recovery. 

Prognosis and outcomes 

Your foot will be in a cast or splint, surgically or not. You won't be able to walk or bear any weight on it. The length of time you must wear the cast will depend on how serious your injury is; it might be eight to twelve weeks.

Long-lasting pain, stiffness, and oedema are possible even after the bone heals. Many individuals can resume their regular activities following treatment, provided that your healthcare professional gives you the all-clear.

If a talus fracture is not well healed or is not managed, it can lead to challenging consequences. Among these difficulties are:^1,3

• Arthritis after trauma: There is cartilage all around your talus bone. The cartilage around your talus is likely to also be damaged with the fracture. Your joint may experience wear and strain if your cartilage becomes uneven. Arthritis may result from this.

• Osteonecrosis or avascular necrosis: A fracture may stop the blood flow to your talus bone. Your bone cells will perish if your blood supply isn't enough. Your bone may collapse as a result of this.

FAQs

Can you walk on a fractured ankle?

The type of talus fracture will determine how things turn out. A talus fracture may result in serious harm. Your ankle and foot joints may become much less mobile and functional as a result of a talus fracture. Your ability to walk and support your weight on your foot may be impacted by this.

How long will a fractured ankle take to heal?

Depending on how serious your injury is, you could need to wear a cast for up to 12 weeks. Even after the cast is taken off, you might still have discomfort, swelling, and stiffness.

Is ankle fracture serious?

The seriousness of the fracture depends on what type of fracture it is. Although minor fractures can heal on their own, more serious fractures will require surgery

Can I move my ankle if it's fractured?

Ankle fractures frequently hurt a lot more than a sprain, where you can normally walk on your ankles. Most patients who have an ankle fracture are unable to bear weight on it.

Summary

If you suspect you may have damaged your ankle after falling or twisting it because it aches a lot, hurts more when you put weight on it, feels extremely stiff, or has significant swelling or bruises, you should get a checkup done. You could have broken your ankle, so get medical help as soon as you can. For proper healing, it will require therapy after the cast has come off.

If you're not sure whether your ankle is fractured, don't worry! Have it examined by a physician anyway.

To determine whether your ankle is fractured and to what degree, you will often get an X-ray. You might not require medical attention if your fracture is quite small.

For a more significant fracture, you could require: 

• a unique boot designed to support your ankle
• a plaster cast to stabilise your ankle until the bones heal so a doctor can realign them (they'll give you an injection to numb your ankle)
• surgery to mend the fractured bones
• Typically, follow-up consultations are scheduled to ensure that your ankle is recovering appropriately.