Talus fracture in children

Talus #
Very rare 0.01 0.08%
Most common talar neck #
osteonecrosis, may be more common
in adolescents than in adult

Anatomy

Head, neck and body

Head mostly cartilagenous
Neck vascular perforation
Tarsal canal funnel shaped sulcus
between talus and calcaneum
Posteromedial to anterolateral opening
as funnel shaped sinus tarsi
Accommodates artery of sinus tarsi and
tarsal canal

 2/3 is covered with articular cartilage

Lateral process gives attachment to
lateral talocalcaneal ligament
Ossification begins in head and
neck and then proceeds to body in a
retrograde fashion
Less ossified more resistant to
permanent damage and can remodel
Last to ossify - subchondral ankle
mortise

Osteonecrosis
Long term disability
AVN of the body as it received the blood supply
from head and neck
Body artery of tarsal canal
Branch of posterior tibial artery
Gives of deltoid branch before it enters the sinus
Deltoid branch medial quarter of talar body
Artery of tarsal sinus is derived from posterior
lateral perforating branch of Peroneal artery and
lateral branch of dorsalis pedis artery.

Clinical features
Forced dorsiflexion
Compartment syndrome
Soft tissue compromise

Classification
Hawkins classification
Type I Stable, undisplaced vertical fracture
through talar neck
Type II Displaced fracture with subtalar joint
subluxation or dislocation; normal ankle
joint
Type III with subluxation or dislocation of
both the ankle and subtalar joint
Type IV type III with talonavicular joint
displacement

Management
CT scan with 3D reconstruction
Approaches posterolateral,
anteromedial and anterolateral

Fractures of the Lateral Process of the Talar Body

Initially missed in 46% of patients

Increasing popularity of
snowboarding
Combination of ankle dorsiflexion
with inversion of the hindfoot
Mimicking a lateral ankle sprain

Fractures of the Talar Body and Dome

Fractures of the Osteochondral Surface of the Talus

Letts found medial

lesions in 79% of
24 children, lateral
lesions in 21%

Adaptation of the Berndt and Hardy (1951) classification

of osteochondral injuries of the talus by Anderson et al

Complications
Skin necrosis
AVN

AVN
Osteonecrosis seems to occur within
8 weeks of injury
Hawkins sign - would not be easily
seen in young children
Rammelt et al - immature talus may
be more susceptible to it
Protected weight-bearing while
awaiting reossification of the talar

Ankle arthrodesis
Attempt should be made to create broad,
flat, cancellous surfaces that are placed
into apposition to allow fusion to occur
The arthrodesis site should be
stabilized with rigid internal fixation,
if possible, or with external fixation
The hindfoot should be aligned to the
leg and the forefoot to the hindfoot to
create a plantigrade foot.

optimal position for

ankle fusion
0 degrees of flexion, 0 to 5
degrees of valgus, and 5 to 10
degrees of external rotation with
slight posterior displacement of
the talus

Phoenix ankle arthrodesis nail

system

 Pre-assembled/preembedded CoreLock
mechanism is capable
of 7.0 mm of inboard
tibiotalar compression.
Once the CoreLock
mechanisms are
engaged, the nail
converts to a
solid,fixed angle
device.

 Tibiotalar
compression and
locking is achieved
independently from
the talocalcaneal
joint, providing the
ability to compress
the subtalar and
ankle joints
separately.