Transcript Fractures of the talus

Fractures of the talus
Rare, resulted from high energy trauma (fall from
height or road traffic accident). The fractures might
occur in head, neck, body, or lateral process. Might
associated with dislocations of midtarsal, subtalar,
ankle joints, or complete talar dislocation. There are
pain, sever swelling, deformity and skin tenting
which may lead to skin sloughing, and skin laceration
sometimes.
Imaging: X ray shows the type and severity of fractures
and associated injuries , CT scan is of important
value, MRI and radioactive isotope might be used.
Fracture talus and fixation
Treatment:
Undisplaced fractures treated by below knee P.O.P in planter
flexion for 8-12 weeks
Displaced fractures: closed reduction , if failed open
reduction and internal fixation followed by POP for 8-12
weeks. Non weight bearing continue for other 8-10 weeks.
Complications:
1- Skin damage.
2- Avascular necrosis of the body of the talus.
3- Nonunion.
4- Osteoarthritis.
Fractures of calcaneum
In most cases the patient falls from a height, often from a ladder, onto
one or both heels. Over 20 per cent of these patients suffer
associated injuries of the spine, pelvis or hip.
The fractures might be extra-articular fractures or intra-articular
fractures (runs into superior articular surface involving subtalar
joint.
Clinical features: There is usually a history of a fall from height or road
traffic accident . The foot is painful and swollen and a large bruise
appears on the lateral aspect of the heel, after1-2 days ecchymosis
spreads into the sole of the foot . The heel may look broad and
squat.
Always check for signs of a compartment syndrome of the foot
(intense pain, very extensive bruising and diminished sensation,
with pain on passive toe movement).
Fracture calcaneum
Fracture calcaneum and associated
wedge fracture body of the vertebra
X- ray in lateral and axial view may shows chip, split, or crush
fractures, CT sometimes used to assess the fracture details.
Treatment:
Elevation and ice packing till the swelling subsides.
Displaced avulsion or intra-articular fractures needs open
reduction and internal fixation followed by elevation and
non-weight bearing mobilization for 8 weeks.
Undisplaced fractures need p.o.p immobilization for 4 – 6
weeks followed by pressure bandage with analgesic .
Comolications:
1- Stiffness of subtalar joint and midtarsal joint causing
difficulty in walking especially on uneven surfaces.
2- Osteoarthritis.
3- Broadening of the heel: problems in shoe fitting.
Fracture base of 5th metatarsal
This injury is very common, caused by foot torsion.
It is nearly always caused by a twisting injury in
which the foot is forced into inversion and
equines (planter flexion), the styloid process at
the base of the 5th metatarsal being pulled off by
the tendon of the peroneus brevis muscle, which
is inserted into it . There is pain and tenderness
over lateral side of foot. It regarded as muscle
injury. Treated by pressure bandage and
analgesia, if pain sever a below-knee walking
plaster for 3 weeks.
Fracture base of 5th metatarsal
Metatarsal stress fracture ( March
fracture)
Young adult (a military recruit or a nurse) or osteoporotic
women affected usually, the foot may become painful
and slightly swollen after overuse. A tender lump is
palpable just distal to the midshaft of a metatarsal
bone (usually the second metatarsal) .
X-ray appearance may at first be normal but a
radioisotope scan will show an area of intense activity
in the bone. Later a hairline crack may be visible and
later on a callus. No displacement occurs and neither
reduction nor splintage is necessary. The forefoot may
be supported with an elastic bandage and normal
walking is encouraged.
March fracture