FRACTURES OF THE TALUS

¹ Medical Corps, Army of the United States

1. The circulation to the talus is deficient, but clinical evidence would indicate that the blood supply enters through the many ligamentous attachments of the talus, and not solely through the articular branch from the dorsalis pedis artery, which enters the superolateral aspect of the neck of the talus.

2. In fractures without displacement, whether of the body or of one of the articular surfaces or processes, the prognosis is good. Aseptic necrosis did not develop in these cases and, after adequate immobilization in a plaster boot, complete function was restored.

3. When the fracture is comminuted and a fragment is displaced in such a manner that it will interfere with motion, the fragment must be removed or replaced. Replacement is preferable for, if the fragment unites, the result is likely to be better.

4. Displaced fragments must be reduced accurately. When there has been a partial forward displacement of the posterior portion of the subtalar joint, closed reduction is feasible and usutally successful. It is extremely important that the reduction be checked by a true lateral roentgenogram, to determine whether or not the superior articular surface of the talus is in satisfactory alignment. With adequate immobilization and accurate reduction, there is every likelihood of a good result without aseptic necrosis.

5. When the dislocation was complete and the talar body was displaced behind the tibia, attempts at closed reduction were unsuccessful in our hands. In spite of accurate open reduction, the results were poor. Aseptic necrosis appeared in all three of these cases. Subtalar arthrodesis should be done at the time of open reduction. This will stabilize the damaged joint and will increase the circulation to the proximal fragment. If there is an associated fracture of the medial malleolus, or so much destruction of articular cartilage that the prospect of a good result is poor, arthrodesis of the ankle joint should be done at the first operation.

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