A Bad Actor in the Talus — What Now?

The recent CORRelations post in the Fractures & Trauma section about talar neck fractures with proximal extension into the talar body (covered previously and slightly differently in the Foot & Ankle section) is one everyone operating on complex trauma in the foot and ankle needs to read. At the end of the post, there is a great image of the fracture in question. The authors of the source article nicely describe this bad actor in talar neck fractures, and the concerns were nicely underscored in another commentary by Dr. Heather Vallier, a very well-known expert in talar fractures.

So, what do we do with this information?

• Set expectations!

We often tend to “hope for the best” even after we operate on patients with severe injuries. This study emphasizes that we have a duty to inform patients who have this fracture pattern that this going to be a challenging injury, and to help them to understand what their future is probably going to look like.

Patients need to know that half of these injuries develop osteonecrosis, one in seven develops collapse, and about 25% of them do not unite. It’s a hard conversation, but one we need to have.