Talus Fractures: Evaluation and Treatment

Christopher Lee, MD; Dane Brodke, MD; Paul W. Perdue, Jr, MD; Tejas Patel, MD


J Am Acad Orthop Surg. 2020;28(20):e878-e887. 

In This Article

Abstract and Introduction


The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Talus fractures are rare but disabling injuries to the hindfoot and remain challenging to treat, despite recent advances in management.[1] Multiple articulations, tenuous blood supply, and complex structure create particular difficulty in achieving acceptable outcomes even with optimal treatment. Adding to these challenges, the incidence of talus fractures is anticipated to increase because improving passenger safety in motor vehicle collisions increases survivorship without commensurate declines in foot trauma.[2]