Diagnostic Approach and Treatment of Dorsal Talus Fractures

Diagnostic Approach

• Initial evaluation should include standard ankle radiographs, but these may miss subtle fractures or underestimate the extent of injury, according to the American College of Radiology 1, 2
• CT is the first-line imaging study after radiographs to determine extent, displacement, comminution, intra-articular extension, and associated injuries, as recommended by the American College of Radiology 3, 4
• MRI is valuable for assessing associated bone marrow contusions, osteochondral injuries, and soft tissue damage, especially important for talus fractures which are at higher risk for osteonecrosis, according to the American College of Radiology 3, 4
• The Broden view (supine flexed knee view with 30-45° internal rotation) can be helpful for evaluating lateral process fractures of the talus, as suggested by the American College of Radiology 3

Treatment Algorithm

For Non-displaced or Minimally Displaced Fractures

• Simple immobilization is appropriate when fracture fragments are small, non-articular, or minimally displaced, as stated by the American Academy of Family Physicians 5
• Protected weight-bearing with immobilization in a cast or fixed-ankle walker-type device is recommended by the American Academy of Family Physicians 5
• Radiographic follow-up at approximately 3 weeks to confirm adequate healing is advised, according to Praxis Medical Insights 6

For Post-operative Management

• Active finger motion exercises should be initiated as soon as stability allows to prevent stiffness, as recommended by Praxis Medical Insights 7
• Protected weight-bearing until radiographic evidence of healing is advised by Praxis Medical Insights 6
• Regular radiographic follow-up to monitor for complications is recommended by Praxis Medical Insights 6