Talus Fractures: Surgical Options and Risks Explained

Talus fracture

Hello Doctor, I have a fracture of the talus in my left foot that has not been surgically treated for a month.
An X-ray showed that the talus has shifted downward near the fibula, causing an uneven surface between the talus and the calcaneus.
A subsequent CT scan revealed slight rotational displacement, and I can feel a bony prominence that affects my ability to dorsiflex the foot and prevents me from squatting.
When I dorsiflex my ankle, a bony fragment beneath the calcaneus slides down, and when I extend my foot, it pops up from that area.
The prominent area cannot slide down or pop out.
It has been over a month since the incident.
Do you recommend surgery to try to fix this? What are the risks? How significant are the risks? What are the pros and cons of having surgery versus not having it? I appreciate your help, as I feel lost and uncertain.

Dongdongdong, 20~29 year old female. Ask Date: 2018/10/13

Dr. Li Yongheng reply Orthopedics

Hello, if the joint surface fracture is uneven by more than 3 mm, it is an indication for surgery.
However, since you are young and the fracture has been present for a month, there should be some initial healing, which may increase the difficulty of the surgery.
Therefore, if the displacement exceeds 3 mm, I recommend surgical treatment.
The risks of surgery include infection, malunion or nonunion of the fracture, and avascular necrosis.
If surgery is not performed, there is a higher likelihood of developing post-traumatic arthritis in the future.
Wishing you a speedy recovery.

Reply Date: 2018/10/13

More Info

Talus fractures, particularly those that involve displacement or rotation, can be quite complex and may lead to significant complications if not addressed properly. Given your situation, where you have experienced a talus fracture for over a month with noted displacement and irregularities in the joint surfaces, it is essential to carefully consider your surgical options and the associated risks.

Surgical Options for Talus Fractures
1. Conservative Management: In some cases, if the fracture is non-displaced and stable, conservative treatment involving immobilization in a cast or boot may be sufficient. However, given your description of the fracture being displaced and affecting the joint surfaces, this option may not be viable for you.

2. Surgical Intervention: If the fracture is displaced, particularly with rotational components, surgical intervention is often recommended. The goals of surgery would be to realign the fractured bone fragments, stabilize them, and restore the normal anatomy of the ankle joint. This may involve:
- Open Reduction and Internal Fixation (ORIF): This procedure involves making an incision to access the fracture site, realigning the bones, and securing them with plates and screws.

- Arthroscopy: In some cases, minimally invasive techniques may be used to address the fracture and any associated joint issues.

Risks of Surgery
While surgery can be beneficial in restoring function and alleviating pain, it is not without risks. Common risks associated with talus fracture surgery include:
- Infection: Any surgical procedure carries a risk of infection, which can complicate recovery.

- Nonunion or Malunion: There is a possibility that the bones may not heal properly, leading to persistent pain or dysfunction.

- Avascular Necrosis: The talus has a limited blood supply, and fractures can disrupt this. If the blood supply is compromised, it can lead to avascular necrosis, where the bone tissue dies due to lack of blood.

- Stiffness and Loss of Range of Motion: Post-surgical stiffness is common, and physical therapy may be required to regain full function.

- Nerve or Blood Vessel Damage: There is a risk of damaging surrounding nerves or blood vessels during surgery.

Benefits and Drawbacks of Surgery vs. Conservative Treatment
Benefits of Surgery:
- Restoration of Joint Function: Surgery may help restore the normal anatomy of the ankle, allowing for better function and range of motion.

- Pain Relief: Proper alignment can alleviate pain associated with the fracture and joint irregularities.

- Prevention of Long-term Complications: Addressing the fracture surgically may prevent complications such as arthritis or chronic instability.

Drawbacks of Surgery:
- Recovery Time: Surgical recovery may take longer than conservative management, and you may require physical therapy.

- Surgical Risks: As mentioned, there are inherent risks with any surgical procedure.

- Potential for Future Surgeries: If complications arise, additional surgeries may be necessary.

Conclusion
Given the complexity of your talus fracture and the symptoms you are experiencing, it is crucial to have a thorough discussion with your orthopedic surgeon. They can provide a detailed assessment of your specific case, including imaging studies, and help you weigh the potential benefits and risks of surgery versus conservative management. It is also important to consider your lifestyle and activity level when making this decision. Ultimately, the goal is to restore function and minimize long-term complications, so ensure that you feel comfortable with the treatment plan moving forward.

Similar Q&A

Potential Long-Term Complications After Talus Fracture and Surgery

Hello, I had an open fracture and dislocation of the left talus along with ligament tears due to a car accident in mid-September last year. I underwent internal fixation surgery in October, where two metal screws were placed: one to stabilize the fractured talus and the other to ...

Dr. Shi Guozheng reply Orthopedics
If the situation you mentioned occurs, treatment should be initiated, and it will require monitoring for about six months to a year before signs of ischemic necrosis may appear. If it does develop, it could lead to joint surface depression, further progressing to arthritis, which...

Ankle Fracture and Ligament Tear: Recovery and Treatment Options

Hello, doctor! I was in a car accident, resulting in a fracture of the talus bone in my ankle and a rupture of the surrounding ligaments (which was assessed using ultrasound). I have undergone minimally invasive surgery on the talus bone, where two fixation screws were placed (th...

Dr. Shi Guozheng reply Orthopedics
Typically, if a joint injury involves a fracture, the damage to the ligaments may be less severe because most of the external force is absorbed by the bone. Therefore, after fracture surgery, there is usually significant improvement, and currently, there is no need for PRP (plate...

Understanding Calcaneal Fractures: Concerns About Recovery and Arthritis Risk

Hello, Doctor, I had a fall from an A-frame ladder on the night of April 6th and was immediately taken to the emergency room. I was diagnosed with a comminuted fracture of the calcaneus with subtalar joint collapse. I was asked on-site if I was willing to undergo surgery, and aft...

Dr. Shi Guozheng reply Orthopedics
Achieving complete reduction of the joint surface in a calcaneal comminuted fracture through open reduction and internal fixation (ORIF) can be challenging. If the current management approach has been taken, it is acceptable. However, if the alignment of the joint surface is sign...

Understanding Ligament Injuries: Surgery Options for Ankle Ligament Tears

Hello, after the car accident, I suffered a rupture of the medial collateral ligament of the ankle along with a closed fibular fracture. The doctor said that the fracture can be treated non-operatively, but the ligament must be surgically repaired. Is it possible to avoid surgery...

Dr. Li Wenlin reply Orthopedics
Hello, In response to your question, both the inner and outer sides of the ankle have strong ligaments. Generally, in cases of a typical sprain, the ligaments on the outer front side are injured. Usually, rest, reduced activity, or immobilization with a cast is sufficient for r...