TALUS ANATOMY,BLOOD SUPPLY OF TALUS, MECHANISM OF INJURY, AVIATORS ASATRALAGUS, HAWKIN'S CLASSIFICATION, TALUS NECK FRACTURE, CANALE VIEW X RAY, HAWKIN'S SIGN, MANAGEMENT AND COMPLICATION.

1. TALUS
FRACTURES
Dr. Anshu Sharma
Assistant Prof.
Dept. of Orthopaediscs, GMC&H

2. Introduction
 The heel bone of horse was used as dice and was
called Taxillus. This Word evolved into Talus
 In 1919, Anderson published a series of foot injuries
sustained by aviators in World War I which he called
Aviator's Astralagus.
 In 1970, Hawkins developed a classification of talus
fractures, which provided guidelines for treatment as
well as the prognosis of different fracture types
 Later on, Canale and Kelly Expanded the HAWKINS
classification system and introduced type 4 .

3. OSSEOUS ANATOMY OF
TALUS
 Talus is one of the 7 tarsal bones of the foot.
 It acts as a connecting link between the Foot
and the Leg
 It is unique as 60% of it’s surface is articular,
which articulates with Tibial plafound, Medial
malleolus, Lateral malleolus, Calcaneum, and
Navicular bones.
 It has Ligamentous and Capsular attachments,
but no muscular attachments

4. Talus has
A. Head
B. Neck
C. Body
D. Lateral Process
E. Posterior Process
Parts

5. Head
Head is intra-articular
• Anteriorly : NAVICULAR bone
• Inferiorly : Sustentaculum Tali of
Calcaneum
Head is supported inferiorly by Plantar
Calcaneo-navicular or Spring ligament
All three together form Talo-Calcaneo-
Navicular joint

6. Neck
 NECK is non-articular
 Directed forward , medial word ,
downward
 It forms 15˚ angulation medially with
the body
 Medial - Sinus Tali corresponds with
Sinus Calcani to form TARSAL
CANAL
 Lateral - tarsal canal opens into
funnel shaped TARSAL SINUS

7. .
 .

8. Body
BODY :
• Superior surface
• Inferior surface
• Lateral surface
• Medial surface
• Posterior surface

9. Lateral process
LATERAL PROCESS :
• Wedge shaped
• Superiorly and Laterally - Lateral
malleolus
• Inferiorly and Medially -
Calcaneum

10. Posterior process
POSTERIOR PROCESS :
• It has Medial and Lateral tubercle
• FHL passes in between.
• Lateral : Anterior, Lateral, and Posterior Talofibular
Ligament
• Medial : Deltoid ligament
• OS TRIGONUM - seen in 50% people, develops
from separate ossification centre posterior to Lateral
tubercle.

11. VASCULAR ANATOMY OF
TALUS
 Talus -60% of it’s surface is articular
 It receives blood supply through Capsular and Ligamentous attachments, and
Nutrient foramen in the Neck
 Talus is supplied by
A. Anterior Tibial artery
- Dorsalis Pedis artery
B. Posterior Tibial artery
- Posterior tubercle artery
- Artery of Tarsal Canal
- Deltoid artery
C. Peroneal artery
- Artery of Tarsal Sinus

12. Anterior tibial
artery (16.2%)
Posterior tibial artery
(47%)
Perforating artery(16.9)

15. >Head and Neck - by DPA
>Body
- Medial 1/3 - Deltoid lig
- Middle 1/3 - Artery of Tarsal Canal
- Lateral 1/3 - Artery of Tarsal Sinus
>Posterior tubercle
- Branches from Posterior Tibial artery

16.  Crucial Anastomotic Sling is
formed in the Tarsal canal b/n
Artery of Tarsal canal and Artery
of Tarsal Sinus
 It gives branches to the Body of
Talus from Distal to Proximal
 In # Neck of Talus, this is
disrupted leading to
Osteonecrosis of Body of Talus

17. TALAR FRACTURES
 2nd most common tarsal # after Calcaneal
#

18. CLINICAL
EXAMINATION
 Patients presents with h/o trauma
 Followed by c/o Pain and swelling of the
hind foot
 Restriction of movements of the ankle
 O/E : Tenderness over Talus and Subtalar
joint
: Restriction of Ankle and Subtalar
movements

19. RADIOLOGICAL
EXAMINATION
X- RAYS
1. AP VIEW
2. LAT VIEW
3. CANALE VIEW
- For better visualization of neck
of Talus
A view of the talar neck achieved by
placing the foot plantigrade on the x
ray film and angling the beam at
75degrees top the perpendicular.

20.  CT SCAN - required to detect the fracture pattern
 MRI SCAN - may be done to identify the soft tissue
injury

21. CLASSIFICATION
 TALAR HEAD FRACTURES
 TALAR NECK FRACTURES
 TALAR BODY FRACTURES
 LATERAL PROCESS FRACTURES
 POSTERIOR PROCESS FRACTURES

22. TALAR HEAD
FRACTURES
 MECHANISM OF INJURY:
• Fall from height, with Foot in plantar
flexion and compression force along
the long axis of the forefoot
Talo-Calcaneo-Navicular joint
disruption
Shortening of the medial column
Loss of the Medial longitudinal arch

23. TREATMENT

25. TALAR NECK
FRACTURES
 Most common type of Talar
Fractures
 It is so called, if # inferior line
is distal to Lateral process of
Talus
 AVIATORS ASTRAGALUS :
Pilots resting the sole of
the foot on the rudder bar in
crashing plane at the point of
impact causes
Hyperdorsiflexion of ankle
causing Talar neck #

26. MECHANISM OF
INJURY
With Hyperdorsiflexion, Posterior capsular ligament of Subtalar jt
rupture and Neck of Talus impacts against Anterior edge of Tibia,
leading to TALAR NECK #
With continuation of dorsiflexion force, Calcaneus with rest of foot
sub luxate forward, leading to Subtalar Subluxation
With continuation of dorsiflexion force, Posterior capsular ligaments
of ankle jt, Posterior Talo-fibular lig, and Deltoid lig rupture
Body of Talus is the wedged Postero-medially out of Tibial mortise,
b/n Medial malleolus and Tendo-achilles, leading to Subluxation of
ankle jt
With further dorsiflexion, Talo-navicular jt subluxation occurs

27. HAWKIN’S
CLASSIFICATION
 Type I : Nondisplaced
 Type II : Displaced with Subtalar
Subluxation
 Type III : Assoc with Subtalar and Ankle
subluxation
 Type IV : Assoc with Subtalar, Ankle and
Talo-Navicular subluxation
AVN
TYPE I 0-25%
TYPE II 25-50%
TYPE III 50-75%
TYPE IV 75-100%

30. TREATMENT

31. SURGICAL APPROACH
Type II, III, IV are difficult to obtain anatomical reduction by closed reduction

34. TALAR BODY
FRACTURES
 It is so called, if # line is proximal to Lateral
process of Talus
 Incidence of AVN is same in Neck and
Body #, but Post-traumatic arthritis is more
with Body #.

35. MECHANISM OF
INJURY
 Axial compression of Talus between Tibial
Plafound and Calcaneum.
 Occurs due to fall from height or Motor
vehicular accidents

36. CLASSIFICATIO
N

37. TREATMENT

38. CALCANEOTIBIAL FUSION
BLAIR TIBIO-TALAR SLIDING GRAFT
ARTHRODESIS
Antero-lateral incision Antero-lateral incision
Talectomy done Comminuted # fragments are removed
Posterior Displacement of navicular to
come in contact with Tibia
Sliding graft from anterior surface Tibia
used to fill the gap
Painless and stable No Posterior displacement of navicular
Decrease in Height and length of foot Foot is not shortened
Ankle and Subtalar jt are lost Subtalar and Talo-navicular jt are intact
Compensatory Midtarsal movements are
present
Subtalar and Midtarsal movements are
present

42. LATERAL PROCESS OF
TALUS #
 Lateral process # occurs on
EVERSION OF DORSIFLEXED AND
AXIALLY LOADED FOOT
 Seen in Snowboarding injuries
 Lateral process has attachments to
Anterior, Lateral and Posterior Talo-
fibular ligaments
 V-sign for Radiographic diagnosis

43. V- sign

45. TREATMENT

47. POSTERIOR PROCESS
OF TALUS #
 Posterior process of Talus has
Medial and Lateral tubercles
with FHL passing in the groove
 Medial tubercle - Deltoid Lig
 Lateral tubercle - Posterior
Talofibular lig

48. MECHANISM OF
INJURY
 Medial tubercle of Posterior
process # - Forceful eversion of
the ankle
 Lateral tubercle of Posterior
process # - Forceful inversion of
the ankle

49. TREATMENT
 Undisplaced - Conservative
 Displaced - ORIF with Herbert screw
fixation

50. COMPLICATIONS OF
NECK OF TALUS #
.

51. 1. OSTEONECROSIS of Body of Talus :
in # neck of Talus, Due to loss of blood supply
- TALECTOMY + TIBIOCALCANEAL FUSION
- BLAIR TIBIO-TALAR SLIDING GRAFT ARTHRODESIS
2. Post-traumatic Arthritis
3. Malunion of Neck of Talus
- CORRECTIVE OSTEOTOMY OF NECK
4. Skin necrosis

52. HAWKIN’S SIGN
Osteonecrosis is identified based on AP
radiograph between 6 and 8 weeks.
Subchondral lucency is indicative of
relative osteopenia secondary to bony
resorption and an intact blood supply.
Progresses from medial to lateral due to
vascular re-establishing from medial side
of dome through deltoid ligament.
Indicative of diffuse osteopenia with
vascular congestion suggests continuity of
blood supply

53. Thank you !!
.