Talus Fracture

The talar neck is the most common location.


  Initial Treatmentt
Splint type & position Lower extremity splint with ankle at 90 degrees 
Initial follow-up visit Within 7 days for definitive casting 
Pt instructions Remain non-weight bearing
Icing and elevation are importantp>
  Follow-up Care
Cast or Splint type & position Avulsion: SLWC, anterior--neutral; posterior--15 degrees equinus
Neck: SLNWBC followed by SLWC
Head: SLWC
Talar dome (types I and II): activity restriction or SLWC
Length of immobilization Avulsion: 4 weeks
Neck: SLNWBC for 4 to 6 weeks; then SLWC for 4 weeks
Body: 6 to 8 weeks
Head: 6 to 8 weeks followed by longitudinal arch support for 3 to 6 months
Healing time 8 to 12 weeks for complete clinical healing (avulsion fractures, 6 to 8 weeks)
Possible pain and stiffness for months
Follow-up visit interval Every 2 to 4 weeks
Repeat radiography interval Neck: every 2 to 3 weeks to assess healing (look for signs of AVN)
At 4 to 6 weeks after injury (some radiographic healing should be apparent)
Pt instruction Ankle and foot ROM exercises and calf stretching and strengthening after immobilization
Good arch support important during rehabilitation
Indications for Ortho consult Indications for Ortho consult Displaced or comminuted fractures
Intraarticular fractures of the talar head
Large avulsion fractures
Stage III or IV talar dome fractures
Stage I or II talar dome fractures with persistent symptoms after 4 to 6 months of conservative treatment
AVN, avascular necrosis; ROM, range of motion;  SLNWBC, Short-leg non-weight bearing cast;  SLWC, short-leg walking cast.

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