Complex fractures of the talus.

Injuries of the talus make up a significant proportion of complex foot and ankle injuries. The severity of these injuries is increasing because the availability and use of better safety equipment has allowed more people to survive serious accidents. Early rigid and accurate anatomic fixation lead to the best possible outcome for each category of talar injury. If osteonecrosis is suspected, titanium screws should be used for fixation to allow better postoperative follow-up. Treatment of osteonecrosis of the talus still depends mainly on clinical judgment, with the MRI providing more clinical data. The outcome of the osteonecrotic talus has not been established at this point. The approach to the talus depends on the judgment and skill of the surgeon; two approaches usually are indicated for more severe injuries. A CT scan is quite helpful for fractures of the talar body; preoperative planning and the judicious use of malleolar osteotomy with preservation of the deltoid artery are advocated. Tibiotalar and talocalcaneal motion have been altered as a result of talar fractures. Arthrosis of the subtalar joint depends on the degree of injury.