Talus Fracture Treatment Options
A talus is a broken ankle bone. The talus is the bone in the back of the foot that connects the leg and the foot. It joins with the two leg bones (tibia and fibula) to form the ankle joint, allowing for upwards and downwards motion of the ankle.
Talus fractures may be treated in a cast, or surgery may be recommended.
Nonsurgical Treatment: Nonsurgical treatment is recommended for fractures in which the pieces of bones remain close together, and the joint surfaces are well aligned. Patients who smoke or have diabetes or poor circulation may be treated without surgery, due to the very high risk of developing complications if surgery is performed.
Surgical Treatment: For a majority of patients, surgical treatment is the correct form of treatment. The goal of surgery is to restore the size and shape of the talus. Sometimes this is a problem as the multiple fragments of bone are like putting together the pieces of a difficult puzzle.
Open Reduction and Internal Fixation
When the bone has several large pieces, your surgeon will perform open reduction and internal fixation (ORIF). This procedure involves making a cut on the outside of your foot and placing a metal plate and/or screws to hold the bones together until healing occurs. The procedure allows for maximal recovery of the inward and outward motion of the foot.
Recovery can be prolonged. No weight or walking on the leg will be allowed for 8-12 weeks. Once the bone is healed, exercise and physical therapy is started to maximize the function of the ankle. The patient should expect some swelling about the foot for several months after the procedure.
The injury can be very debilitating with persistent pain, stiffness, and swelling, even after excellent nonsurgical or surgical treatment. However, most people, depending on the type and severity of the fracture, are able to return to most work and recreational activities.
Talus fractures are quite severe injuries and may lead to longstanding problems with the foot and ankle. These problems can be divided into early and late complications.
Early Complications: Early complications are most often related to the significant swelling that can occur after these injuries, causing wound problems and infection. People who smoke, have diabetes, or have poor circulation are at greatest risk for these complications.
Late Complications: Late complications are typically related to the severity of the initial injury. Most people experience a certain degree of stiffness with the upwards and downwards motion of the ankle. When the blood supply to the talus is damaged, it can lead to death of the bone, a condition called avascular necrosis (AVN). This condition can lead to significant deformity and arthritis requiring additional surgery.
Frequently Asked Questions
How long will I be out of work?
This is a severe injury and dependent upon the type of work performed, most people are unable to return to work for at least 2 weeks after the injury. Those without sedentary jobs may not be able to return for 6 months to a year.
Do the plates and screws need to be removed?
The plates and screws serve to hold the bones together so that they can heal. Once the bones are healed, they serve no purpose. However, most surgeons do not recommend removal of the plate and screws unless there are problems with pain or infection.
*Source: American Orthopaedic Foot & Ankle Society® http://www.aofas.org
OrthoInfo.org, website of the American Academy of Orthopedic Surgeons (AAOS)