Fractures of the talus are rare, making up less than 1% of fractures in general trauma practice and 2% of practice in a level 1 trauma centre (Elgafy 2000). However, they are difficult to treat, with a high rate of poor outcomes and complications.
Anatomy
The talus participates in the ankle, subtalar and talonavicular joints, acting as a link between the vertical shank and the obliquely horizontal hindfoot. It serves as an attachment for many ligaments but no muscles, and over 70% of its surface is covered by articular cartilage. Its circulation is therefore somewhat precarious. Blood reaches it from the posterior tibial, dorsal and peroneal arterial trees, entering on the ligaments and the rough area of the neck from an anastomosis in the tarsal canal. The blood supply of the body mostly reaches it by a retrograde route from the neck and is at risk from talar neck fractures. Petersen showed that, in cadaver specimens, increasing fracture displacement produced greater compromise to the blood supply.
Inokuchi defined a fracture of the talar body as one in which the main fracture line exited the inferior cortex of the talus through or posterior to the posterior subtalar facet. Nevertheless, some fractures have both neck and body components.
Neck fracture: fracture line exits inferiorly anterior to posterior subtalar facet
Body fracture: fracture line exits inferiorly into posterior subtalar facet