A 21-year-old male professional player presented after an acute injury to his right ankle. He described “wrenching” his ankle as he slid in for a slide tackle. He was unable to report the exact mechanism but reports his studs getting caught in the turf and sustaining a violent twisting movement. He experienced intense pain and was unable to continue. When he presented to the ED several hours after the injury his foot and ankle were grossly swollen, and he was unable to weight-bear. He had a global restriction of foot and ankle movements.
A lateral x-ray image of the ankle demonstrates a fracture of the body of the talus which extends into the subtalar joint. No significant displacement or other fracture can be seen. There is normal alignment at the ankle joint. CT images further define the fracture and confirm that there is no significant displacement or other associated injuries. The fracture is mildly comminuted and extends from the superior cortex of the anterior talar dome to the medial facet of the subtalar joint.
The player was treated with open reduction and internal fixation within 48 hours of the injury. The potential significance of the injury and the potential complications were outlined prior to surgery. Post-operatively he was immobilised for six weeks and was kept non-weight bearing. At this point ROM exercises and a progressive rehabilitation programme have been initiated. It is hoped that he may be able to return to football training 4-5 months after the injury.
Talar body fractures are rare injuries, especially in football and other similar sports. They are most common after high energy trauma and involve a combination of axial loading and either pronation or supination. In the vast majority of cases surgical treatment is preferred with careful reduction and internal fixation being the most common procedure. The clinical outcomes appear to be determined by the severity of the injury (comminuted fractures, open injuries and those with associated talar neck fractures) and the quality of reduction and internal fixation that is achieved. The timing of surgery does not appear to impact the final result. Unfortunately, despite good surgical treatment, there are high rates of complications associated with this injury. Avascular necrosis, mal- or non-union and post-traumatic osteoarthritis are all relatively common. This is in large part due to the unusual anatomy and biomechanics of the talus. The blood supply to the talus is retrograde, like the scaphoid, while 70-80% of it is covered by articular cartilage. Another contributor is that the talar dome bears more weight per area than any other joint in the body.
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