Talus Fractures

Tyler Snoap
Robert R. Gorman III
Jason W. Roberts

Bony Anatomy

  • The talus has complex anatomy; over 60% of the bone is covered with articular cartilage.
  • The talus articulates superiorly with the tibia and fibula at the ankle joint, inferiorly with the calcaneus at the subtalar joint and anteriorly with the navicular at the talonavicular joint.
  • The inferior portion of the talus has anterior, middle, and posterior facets, which articulate with their respective calcaneal facets.
  • Between the posterior and middle facets is a groove, which exits laterally to form the sinus tarsi.
  • Fractures of the talus are often classified into the body, neck, head, and processes.
  • The talar neck, in relation to the talar body, is oriented 10 to 44 degrees medial and 5 to 50 degrees plantar.
  • Different radiographic views are required to accurately assess each of the anatomic segments and their articulations.

Radiographic Anatomy

AP/Mortise View Ankle

  • Assess involvement and fracture displacement of the talar body.
  • Assess congruence of the tibiotalar articulation.
  • Visualize the lateral process (Figs. 27-127-3).


Figure 27-1 AP view of the ankle: tibiotalar dislocation with evidence of talar neck fracture. Note the talonavicular articulation appears to be intact on this view.


Figure 27-2 Mortise view of the ankle: there is a talar body fracture with an associated vertical medial malleolus fracture.


Figure 27-3 Intraoperative mortise view with definitive fixation of the medial malleolus, talar body, and talar neck.

Lateral View Ankle/Foot

  • Assess congruence of the subtalar articulation.
  • Assess sagittal plane alignment of the tibiotalar, talonavicular, and midfoot articulations (Figs. 27-427-6).


Figure 27-4 Lateral view of the ankle: there is loss of normal contour of the tibiotalar joint with evidence of a talar neck fracture. The talonavicular joint appears congruent on this view.


Figure 27-5 Postreduction lateral view of the ankle: there is a minimally displaced talar neck fracture with intact articulations at the tibiotalar and talonavicular joints. A CT would help assess the subtalar articular congruency and fracture morphology in more detail.


Figure 27-6 Intraoperative lateral view after definitive fixation of a talar neck fracture.

Canale View

  • Oblique imaging of the talar neck that removes the overlap of the calcaneus to more accurately assess the talar neck.
  • Taken with 75 degrees cephalad tilt with foot in 15 degrees eversion and plantar flexion.
  • Allows visualization of the lateral shoulder and medial cortex.
  • This is not a standard injury film; it is more widely used intraoperatively to assess the reduction of the talar neck.
  • AP view of the foot can also assist in evaluating the reduction of the talar neck; however, the Canale view provides more valuable information by assessing the neck in profile while removing the overlap of the talus and calcaneus (Fig. 27-7).


Figure 27-7 Intraoperative Canale view demonstrating reduction and fixation of a comminuted talar neck fracture with dual plating and screw fixation of an associated medial malleolus fracture.

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Mar 25, 2020 | Posted by in ORTHOPEDIC | Comments Off on Talus Fractures
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