Talus Fractures: All I need to know

Closed medial subtalar dislocation: A case report and literature review

Subtalar dislocation is characterized by simultaneous dislocation of the subtalar (talocalcaneal) and talonavicular joints, hence the name talocalcaneonavicular. These lesions can be grouped into four distinct categories: anterior and posterior, which are exceptional, lateral and medial. Medial subtalar dislocations are more frequent, are due to low-energy trauma and generally have good functional results. Anatomical reduction and stabilization of the subtalar joint and optimal management of all associated foot injuries are the key to good results.

Vascular Foramina of Dry Human Talus: A Morphological Study

Background The talus is the second largest tarsal bone and makes the osseous link between the leg and foot region. The branches of the dorsalis pedis, posterior tibial, and peroneal arteries enter vascular foramina (VF) on the various surfaces of the talus and provide intraosseous blood supply. Understanding the morphology and morphometry of VF might be helpful in reducing the risk of vascular injury associated with surgical interventions to the talus.  Aim and objectives The purpose of this study is to contribute reference data for the morphology of VF of talus in a sample from Türkiye. Materials and methods This study was performed on 62 dry talus samples from Türkiye. The number, location, size, and foraminal index of the VF were evaluated on each talus. The total and medial surface lengths, distances of the closest and furthest foramina on the inferior surface, and distances of the closest and furthest foramina on medial surface were measured. Results No VF was detected on articular surfaces and the head of the talus. The majority of VF (1754; 81.17%) were detected on the neck, and 708 (40.36%) were located on the inferior surface of the neck. On the body, VF was mostly detected on the medial surface (233; 57.25%). The mean foraminal indices of the closest and furthest foramina on the inferior surface were 38.85% and 77.89%, respectively. The mean foraminal index of the closest foramina on the medial surface was 33.52%, and the furthest foramina on the medial surface was 63.91%. The total number of VF on 62 tali was determined as 2161. The majority (1521; 70.38%) of the size of VF was ≥0.6 mm. The mean total length was 55.14±4.69 mm, and the medial surface length was 49.18±4.18 mm. Conclusion Knowing the morphologic and morphometric properties of the VF gains importance during surgical interventions to the talus to reduce vascular damage. According to our results, lateral approaches to the talus may be safer than other approaches. To our knowledge, there is no study about the morphology of VF of the talus in Türkiye samples. We believe that the results of this study will provide reference data for morphology and morphometry of VF of talus.

Traumatic subtalar joint dislocation

Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. Failure of urgent reduction might lead to increased risk of conversion to an open injury as a result of pressure necrosis of the overlying skin, risk of talar avascular necrosis and risk of neurovascular compromise. A computed tomography scan is needed in all cases following successful closed or open reduction to identify associated occult foot and ankle fractures. The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.

Subtalar Dislocations

Subtalar dislocations are uncommon injuries that involve disruption of the talocalcaneal and talonavicular joints. Whereas medial subtalar dislocations are usually caused by low-energy mechanisms and are reducible by closed means, lateral subtalar dislocations occur due to high-energy trauma, have associated foot injuries, and may require open reduction. Good outcomes can be expected for low-energy medial dislocations, whereas high-energy dislocations have guarded outcomes. Hindfoot deformity and chronic instability can result from nonanatomic reduction and inadequate stabilization. Arthrosis of the subtalar joint can occur despite anatomic reduction and is attributable to the cartilage damage at the time of injury.