II. Mechanism

  1. Lateral Talar Dome Fracture (usually Trauma related)
    1. Foot inversion with ankle dorsiflexion
    2. Direct Trauma between talus and fibula
  2. Medial Talar Dome Fracture
    1. Foot inversion with ankle plantar flexion
    2. Direct Trauma between posteromedial talus and tibia

III. Symptoms

  1. Intense pain
  2. Inability to bear weight

IV. Signs

  1. Lateral Talar Dome Fracture
    1. Tender anterior to lateral malleolus
  2. Medial Talar Dome Fracture
    1. Tender posterior to medial malleolus

V. Radiology: Ankle XRay

  1. Fracture may not appear for 2 to 4 weeks after injury
  2. Lateral Talar Dome Fracture
    1. Mortise view shows shallow wafer-shaped lesion
  3. Medial Talar Dome Fracture
    1. AP view shows deep cup shaped lesion

VI. Classification (Berndt and Harty)

  1. Stage I: Subchondral bone compression Fracture
  2. Stage II: Osteochondral Fracture fragment (partial)
  3. Stage III: Osteochondral Fracture fragment (detached)
  4. Stage IV: Osteochondral Fracture fragment (displaced)
  5. Reference
    1. Berndt (1959) J Bone Joint Surg Am 41:988-1020 [PubMed]

VII. Management

  1. Consult with orthopedics
  2. Non-weight bearing Short Leg Cast for 6 weeks
    1. Indicated for Stage I-II lateral Fracture
    2. Indicated for Stage I-III medial Fracture
  3. Surgical management
    1. Indicated for Stage III-IV lateral Fracture
    2. Indicated for Stage IV medial Fracture

VIII. Complications: Talar Dome Osteochondritis Dissecans

  1. Avascular necrosis of the talus
  2. Talus covered by cartilage with tenuous blood supply

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