Talus Fracture and Dislocation

　　1. Etiology

　　It is usually caused by compression and squeezing violence.

　　2. Pathogenesis

　　Mostly caused by compression or squeezing violence during high-altitude falls; especially more likely when the foot is extended. At this time, fractures of the neck of the talus are most common, followed by fractures of the talus body. When the foot is in the middle position, it often leads to fractures of the talus body, while fractures of the posterior process of the talus are more common when the foot is plantar flexed. Similar violence can also cause dislocation of the talus.

　　2

　　What complications are easy to occur in talus fracture and dislocation

　　I. Avascular necrosis of the talus

　　Due to the characteristics of blood supply of the talus, this kind of complication is relatively common, especially in patients with complete talus dislocation, and should be paid attention to.

　　In the early stage, non-surgical treatment is the main method, and measures such as avoiding weight-bearing, local immobilization, and blood circulation promoting drug treatment can be taken. If necessary, talus drilling can also be performed to promote blood supply.

　　In the later stage, part or all of the necrotic bone needs to be removed, and then an artificial talus can be implanted, or Blair surgery or tibial talus fusion surgery can be performed.

　　II. Traumatic arthritis

　　It is also relatively common, especially in poor reduction cases. It can also occur after avascular necrosis of the talus.

　　1. In the early stage: Reduce or do not bear weight, the ankle joint can use zinc oxide ointment or ankle brace for immobilization.

　　III. Talus pseudarthrosis: In the later stage, joint fusion surgery is often required, and talus, three-joint, or four-joint fusion surgery can be performed according to the situation; the latter should be used as little as possible, or as the last choice of surgery.

　　Talus fractures are generally divided into the following 5 types:

　　I. Talus head fracture

　　It is mostly in a粉碎状, less common.

　　II. Talus neck fracture

　　It is more common, and it can be divided into different types according to the condition of the fracture.

　　1. Simple talus neck fracture without displacement signs.

　　2. Fracture of the talus neck with posterior dislocation of the talus body, this type is more complex, and there are also many problems in the later stage.

　　III. Fracture of the talus body

　　It can also be divided into 3 types:

　　1. Fracture of the talus body without displacement.

　　2. Fracture of the talus body with displacement.

　　3.粉碎性距骨体骨折.

　　IV. Posterior process fracture of the talus

　　It is easy to be confused with the triangular bone fragment.

　　V. Talus cartilage fracture

　　Mostly caused by mild violence, especially when impacted by collision violence in a twisted situation.

　　Prognosis: After treatment and healing of talus fracture and dislocation, aseptic necrosis and traumatic arthritis often occur, leading to varying degrees of functional impairment of the ankle joint. The patient's diet should be light and easy to digest, with an emphasis on eating more vegetables and fruits, and a reasonable dietary arrangement, paying attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods..

　　1. The density resolution of CT is significantly better than that of X-ray films, which is more conducive to clearly defining the size, scope, and density changes of joint and soft tissue lesions, as well as the invasion of bone disease into adjacent tissues. Certain types of fractures and chondral injury lesions are indications for CT examination.

　　2. Visual examination shows swelling of the ankle, severe pain, and significant tenderness. Active joint movement is absent, and there is a weight-bearing obstacle in the lower limb.

　　1. What kind of food is good for the body for talus fracture and dislocation?

　　It should be enhanced nutrition, eat more protein-rich foods such as fish, eggs, soy products, and appropriately increase calcium. Drink more water, eat more vegetables and fruits such as green vegetables, celery, bananas, etc.

　　2. Foods that are best not to eat with talus fracture-dislocation

　　Avoid spicy foods: such as chili, mustard, etc. Habits such as smoking and drinking should be戒除.

　　I. Treatment

　　1. Fractures without displacement:Generally, the lower leg cast in functional position is fixed for 6-10 weeks. During the period of fixation, if the local swelling subsides and the cast becomes loose, the cast can be changed.

　　2. Reducible fractures:Principally, it is to immobilize with a lower leg cast after manual reduction, and treat according to the following different types of fractures.

　　(1) Talus neck fracture: Under traction, the foot is plantar flexed and slightly inverted, and then pushed backward to reduce the fracture. But the plantar flexion position should not exceed 120°, fixed with a lower leg cast for 2-3 weeks, and then continue to immobilize with a functional position lower leg cast for 6-8 weeks.

　　(2) Talus neck fracture with posterior dislocation of the talus body: Manual traction under (if necessary, talus Stryker wire traction), make the foot plantar flexion and slightly inverted, and then push it backward to reduce the fracture. But the plantar flexion position should not exceed 120°, fixed with a lower leg cast for 2-3 weeks, and then continue to immobilize with a functional position lower leg cast for 6-8 weeks.

　　(3) Mild talus body compression fracture: Traction for 3-5 minutes, then fix it with a functional position of the lower leg cast.

　　3. Fractures that cannot be closed reduced:Referring to the cases of failed manual reduction and comminuted fractures, which often require open reduction and internal fixation according to the circumstances. The surgical methods are divided into:

　　(1) Simple open reduction for those caused by soft tissue entrapment such as joint capsule, can be fixed with long screws, Kirschner wires, etc. The tail of the internal fixation should avoid the articular surface, or be buried under the cartilage.

　　(2) Talocalcaneal joint arthrodesis: That is, early fusion of the talus with the fractured talus body, so as to increase the blood supply source of the talus through the talus and improve the blood supply status of the talus, thereby reducing the incidence of aseptic necrosis of the talus head. It is suitable for those with satisfactory reduction and poor blood supply of the talus body and talus neck fractures.

　　II. Prognosis

　　After the healing of talus fracture-dislocation, aseptic necrosis and traumatic arthritis often occur, leading to varying degrees of functional impairment of the ankle joint.