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


Functional outcomes after fractures of the talus, corresponding to the pattern predicting osteonecrosis and OA, correlate with increasing disruption of the peritalar joints. The AOFAS scores of 74 talar neck fractures included in a recent systematic review were 77, 86, 68, and 68 for Hawkins types I to IV.[16] A 2004 series of 70 displaced talar neck fractures with median 5.2-year follow-up remains one of the most instructive single series on functional outcomes after talar neck fracture.[13] Twenty-six patients required secondary reconstructive surgery, mostly arthrodesis, including 13 within 12 months and 13 after 12 months. The 20 patients who did not require reconstructive surgery and healed without malalignment or developing arthritis had "virtually normal function" with minimal pain and disability. In the series by Vallier et al[12] of 57 talar body fractures with a mean 33-month follow-up, 15 required secondary procedures, 67% returned to their previous level of employment, and the mean Foot Function Index scores were 41 for pain, 37 for disability, and 19 for activity.

Functional outcomes in isolated process or head fractures are somewhat better. Among 20 lateral process fractures with a mean 3.5-year follow-up, the mean AOFAS score was 93, with the score for surgically treated patients (97) higher than that for nonsurgically treated patients (85).[31] All surgically treated patients were able to return to their previous level of sport, as were two of six treated nonsurgically.[31] For talar head fractures, the PROMIS scores at the mean 14.5-month follow-up in 8 surgically treated cases were 42.95 for physical function, 54.57 for pain interference, and 50.84 for disability, all of which are within 1 SD of the population mean.[33]