Talar fracture fixation is an operation to repair a fracture of the talus — a critical bone in the ankle that connects the leg to the foot. Talar fractures are uncommon but important injuries with a high risk of avascular necrosis.
The approach depends on the fracture pattern. For talar neck fractures, incisions are made on the medial (inner) and/or lateral (outer) side of the ankle. The fracture is anatomically reduced and fixed with screws. For talar body fractures, a malleolar osteotomy (cutting the ankle bone) may be needed for access. The operation takes one and a half to three hours.
All displaced talar fractures require surgical fixation. The talus is critical for ankle and subtalar joint function, and any malreduction leads to severe arthritis. Urgent reduction is important to reduce the risk of avascular necrosis.
Undisplaced talar fractures may be managed in a non-weight-bearing cast for eight to twelve weeks with close X-ray monitoring. Displaced fractures require surgery.
CT scan is essential for planning. Urgent reduction and fixation is recommended to reduce AVN risk.
Anatomical restoration of the talus to preserve ankle and subtalar joint function. Outcomes depend heavily on the initial injury severity — the risk of AVN is directly related to the degree of displacement.
The talus has a vulnerable blood supply. AVN risk: 10–15% for type II, 30–50% for type III fractures.
Very common, affecting the ankle or subtalar joint despite good reduction.
Eight to twelve weeks minimum.
Healing in a suboptimal position.
Failure to heal.
The skin over the talus is thin.
Wound or deep infection.
If severe AVN develops, the talus may collapse, requiring ankle fusion or replacement.
General or spinal anaesthesia.
Non-weight-bearing for eight to twelve weeks. Ankle exercises begin once fixation is stable. MRI at three to six months to assess for AVN. Progressive weight-bearing at three months. Full recovery twelve to eighteen months. Some patients eventually require ankle or subtalar fusion if significant arthritis or AVN develops.
Regular X-rays at six weeks, three months, and six months. MRI at three to six months to monitor for AVN. Long-term surveillance for arthritis.
AVN occurs when the blood supply to the talus is disrupted by the fracture. Without blood supply, the bone dies and may collapse. The risk depends on how severely displaced the fracture was.
Many patients with talar fractures eventually require further procedures — either subtalar fusion, ankle fusion, or ankle replacement — due to post-traumatic arthritis or AVN. This depends on the severity of the original injury.