Fracturas de la cabeza, cuerpo y apófisis del astrágalo

Abstract

Introduction

Although infrequent, fractures of the talar head and body should be taken in serious consideration because of the severe sequelae they may entail for the function of the foot.

Talar head fractures

These are usually displaced and involve the talo-navicular joint, which requires a meticulous open reduction, stabilization with screws and sometimes the use of grafts to preserve the talar length; in cases of severe comminution that precludes reconstruction, we believe athrodesis is an efficacious first-line treatment.

Talar body fractures

These are extremely severe injuries that are characterized by a poor prognosis since they tend to be associated with such sequelae as aseptic necrosis and post-traumatic arthritis, both in the ankle and the subtalar joint. If there is a 2 mm separation they must be considered displaced thus requiring open reduction and fixation with screws, so we must be careful with the technique we select to approach these cases in order not to impair blood supply to the region any further.

Fractures of the talar processes

During the first examination, these tend to either go unnoticed or be considered minor injuries. Nevertheless, it has lately been shown that their sequelae can enormously disrupt the function of the foot. These injuries should always be suspected since they could easily be mistaken for a sprained ankle, which could have grave consequences not only for athletes but also for other individuals who could even develop an abnormal gait. When in doubt, a computed axial tomography should be carried out and, when appropriate, the fracture must be reduced and fixated. When the above is not possible, it is preferable to excise a fragment than to be faced with a joint incongruency.