Talar Neck Fracture Surgery

What is a talar neck fracture?

A talar neck fracture is a type of break that affects the talus bone, which makes up part of the ankle joint and the subtalar joint.

What is the goal of surgery for a talar neck fracture?

The goal of surgery is to realign the bone pieces and fix them so they are stable. This is done to reduce the chances of developing arthritis or losing blood supply to the bone.

What signs indicate surgery might be needed?

Surgery for talar neck fractures should be done if the bone has shifted or if the bone has broken through skin.

When should I avoid surgery?

Surgery is not be performed in fractures that haven’t shifted, patients who are sick or elderly and cannot risk having anesthesia, or in patients who have very injured or burned skin overlying the fracture.

General Details of Procedure

During surgery you may have a general anesthetic and be completely asleep or have your entire leg numbed with a nerve block. The bone is typically exposed with one or two incisions and the pieces are realigned. When the fracture is in the appropriate position, your surgeon will fix the bone pieces together with plates and/or screws. Then the incisions are closed and the foot is placed into a cast or splint.

Specific Techniques

Each fracture has a unique fracture pattern, so each surgery requires its own tailored approach. In general, patients will be positioned on their back for surgery. Most surgeons will place a tourniquet on the leg above or below the knee. The surgeon will then make one or two incisions over the bone on either side of the foot. There are important tendons, nerves and blood vessels that are carefully moved out of the way in order to expose the fractured bone.
The surgeon uses many different tools to move the fractured bone into the appropriate position. The bone pieces are then held in position with temporary pins or clamps and the positioning of the bones and joints is checked with an X-ray. When the positioning looks right, the surgeon will place permanent screws and plates across the fracture. The final position of the bone, joints and screws/plates is confirmed on X-ray. The wounds are closed with layers of suture before the foot is placed into a cast or splint below the knee.

What happens after surgery?

You may have a short stay in the hospital depending on the severity of the fracture and other injuries. The surgeon will see you in the office after surgery to remove the cast/splint and sutures. If the fracture was sufficiently stabilized with the plates and screws, you may be placed into a removable boot that will allow you to start moving the ankle to combat stiffness and to bathe.
For certain fractures, your surgeon may decide to place a new cast. You will typically be on crutches, putting no weight on the injured foot for eight to 12 weeks after surgery until X-rays show that the fracture has healed sufficiently.
Some patients will require physical therapy to avoid stiffness and weakness. The complete recovery may take six to 12 months from the time of injury.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Immediate possible complications from talar neck surgery can include wound healing problems and too much swelling in the foot. Patients typically receive intravenous antibiotics prior to surgery, but an infection may still develop in the days and weeks after surgery.
Most wounds will take about two to four weeks to heal safely, but this may take much longer if there were traumatic wounds, or if the patient has diabetes or smokes. In the hours to days after surgery, the foot may swell considerably after a talar neck fracture. If the swelling gets to be too much it may limit blood flow to the foot, resulting in a condition called compartment syndrome. Any of these complications may require another procedure to correct.
Some of the most common long-term complications after talar neck fractures are arthritis and a condition called avascular necrosis (AVN) of the talus. Arthritis can occur after any severe injury to the ankle and is more likely if the fracture has shifted. AVN, which is the death of bone tissue due to a lack of blood supply, is also more frequent with fractures that have shifted.

Frequently Asked Questions

What are my chances of developing arthritis after a fracture of the talar neck?
The talus may develop arthritis at any of three joints: the ankle joint, the talonavicular joint or the subtalar joint. The subtalar joint is directly below the ankle joint and is responsible for most of the side-to-side motion of our foot. This joint has a 46 percent to 69 percent chance of developing arthritis, according to current literature.
What are the treatments if I develop arthritis?
If arthritis develops in one or more joints after a talus fracture, the arthritis can be treated with medication, braces, injections and activity modification. If these treatments are unsuccessful, an additional surgery may be needed.
What if I develop avascular necrosis of the talus?
Avascular necrosis of the talus can be a serious complication of fractures of the talus. AVN can occur with any injury depending on the severity of the fracture. If it does develop, it is not always painful. If it is painful then many of the same treatments for arthritis may be indicated, including fusion surgery.

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