Percutaneous Fixation of Talus Fracture

Acute talar neck fractures (Hawkins type I–III)

Nonunited talar neck fractures (<9 months after injury)

Check for neurovascular deficits and skin conflicts

Exclusion of compartment syndrome

Exclusion of additional injuries that may promote another strategy (e.g., associated ankle fracture or tendon injury)

Appropriate radiographic imaging to assess the fracture of the talus and exclude accompanying injuries to the surrounding bony structures ( Fig. 40.1 )

Mandatory computed tomography (CT) scan to fully understand the fracture type, to recognize extent of lesions to the articular structures, and potential interposed fragments ( Figs. 40.2 and 40.3 )

Magnetic resonance imaging in rare cases where injuries to surrounding soft tissues cannot be excluded through clinical investigation

Close the contact area between the articular surfaces at the ankle and subtalar joint that makes visualization difficult without extended ligament release.

As 60–70% of the talar surface is covered by cartilage, open exposure should be minimized to avoid secondary joint dysfunction.

Main vascular supplies are provided from lateral to the talar head (through afferent vessels from the lateral capsule) and talar neck and body (through afferent vessels from sinus tarsi), and from medial to the talar body (through afferent vessels through the posteromedial capsule/deltoid).

Complex ligamentous apparatus that covers the talar body and neck on the medial (deep and superficial deltoid) and lateral sides (lateral ankle ligaments).

Limited insight into ligamentous apparatus in sinus tarsi (interosseous and cervical ligaments).