Fractures of the Talar Head: A Series of 16 Patients

CATEGORY: Hindfoot; Trauma INTRODUCTION/PURPOSE: Fractures of the talar head are very rare accounting for just 5-10% of talus fractures and fewer than 1% of all fractures. As such, limited clinical literature is available to guide management of these injuries. We present the largest clinical series on talar head fractures to date. METHODS: We performed a retrospective review of all patients presenting to three level-1 trauma centers with major fractures of the talus (fractures of the neck, body or head) over a 14-year period. From this cohort of patients, we identified patients presenting with fractures of the talar head with available computed-tomographic (CT) imaging of the foot allow proper fracture evaluation and characterization. In total, 258 patients with major fractures of the talus were identified. Sixteen patients (6.2%) with talar head fractures met inclusion criteria. RESULTS: Most injuries were due to falls from height and only 4 were isolated. The navicular was fractured in 7 patients (43.8%). Six patients (37.5%) exhibited comminuted fracture patterns, while the remaining demonstrated simpler shear or impaction injuries. Four patients underwent fixation of the talar head, 3 were treated with primary stabilization or fusion of the talonavicular joint, and two patients were treated with head fragment excision. The talar head was managed in a closed fashion in the remaining seven patients, five of which presented with comminuted fracture patterns. Eight patients showed radiographic evidence of post- traumatic arthritis (PTA) at mean follow-up of 15.5 months. In all instances of PTA, the patient had sustained a comminuted talar fracture, an associated navicular fracture or both. CONCLUSION: Talar head fractures are extremely rare injuries with sparse literature to guide clinical management. Simple shearing or impaction fractures may be amenable to surgical fixation with favorable radiographic outcomes. Comminuted fractures and/or concomitant navicular trauma at the time of injury may be associated with increased incidence of talonavicular arthrosis.