Foot Case #1

H&PPt is a 24 yo WM that

jumped out of a 10 foot high window trying to jump into the pool. He landed on his right foot on the pavement. He did not hit anything else and is now complaining of pain in his right foot and ankle. He has been unable to walk since.

Vitals: T:98.6, HR:112, RR:16, BP:128/76

Gen: WD, WN, nontoxic male holding his right ankle

CV: slight tachy, RRPulm: CTA bilaterallyMSK: significant edema over

right ankle and dorsum of foot. Ttp diffusely. No obvious deformity. Decreased ROM at ankle. 2+ pulses. Good cap refill. Neuro intact.

Image

Talar Fracture

A talar fracture can occur at the head, necck, or body. The neck is the most likely location of a talar fracture (as seen above)

Assess neurovascular statusReduce if necessary

Splint with posterior leg and stirrups splints. The ankle should be plantar flexed and everted

15 degrees. Emergent orthopedic consultAppropriate pain management

ED Management

Talar Fractures can occur in 3 different spots on the talus: the body, the head, and the neck.body fx: accounts for 25% and is further divided

into osteochondral, lateral process, posterior process and dome(true body) fractures

Head fx: <10% of talar fxNeck fx: categorized by Hawkins:

1) nondisplaced2) displaced, body subluxed/dislocated from subtalar

joint3) high energy with subluxed/dislocated ankle or

subtalar joint with displaced talar neck

Pearls

Avascular necrosis is very common with talar fractures, especially when fracture is displaced

Talar fractures are associated with medial malleolar fractures in 25% of case.

Pearls Cont.

Talar Body Fx

Other Images

• Talar Neck Fx

http://imaging.consult.com/imageSearch?query=talar&groupByNode=title

http://www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/ankle/case64/case64background.html

http://www.gentili.net/fracture.asp?ID=3Tintinalli, Judith E., Gabor D. Kelen, and J. Stephan.

Stapczynski. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, Medical Pub. Division, 2004.

Wheeles, Clifford. "Wheelesonline.com." Wheelesonline.com. Duke Orthopedics. Web. 04 June 2012. <http://www.wheelesonline.com/ortho>.

References