eMedicine Specialties > Radiology > Musculoskeletal

Talus, Fractures: Multimedia

Author: Julia Crim, MD, Chief of Musculoskeletal Radiology, Professor, Department of Radiology, University of Utah
Contributor Information and Disclosures

Updated: Dec 30, 2008

Multimedia

$Talar body fracture, anteroposterior radiograph. ...$

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Media file 1: Talar body fracture, anteroposterior radiograph. There is a sagittally oriented fracture through the body of the talus and disruption of the tibiotalar and subtalar joints. The injury was from a motor vehicle accident.

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$Talar body fracture, anteroposterior radiograph. ...$

Talar body fracture, anteroposterior radiograph. There is a sagittally oriented fracture through the body of the talus and disruption of the tibiotalar and subtalar joints. The injury was from a motor vehicle accident.

$Talar body fracture, lateral radiograph (same pat...$

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Media file 2: Talar body fracture, lateral radiograph (same patient as in Images above and below). There is a significant degree of comminution of the talar fracture, with comminuted fracture lines extending into the posterior and lateral processes of the talus.

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$Talar body fracture, lateral radiograph (same pat...$

Talar body fracture, lateral radiograph (same patient as in Images above and below). There is a significant degree of comminution of the talar fracture, with comminuted fracture lines extending into the posterior and lateral processes of the talus.

$Talar body fracture (same patient as in Images ab...$

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Media file 3: Talar body fracture (same patient as in Images above). Coronal computed tomography (CT) scan through the posterior subtalar joint. There is wide separation of the talar fragments. The degree of the subtalar joint dislocation and the marked comminution of the medial portion of the talus are evident.

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$Talar body fracture (same patient as in Images ab...$

Talar body fracture (same patient as in Images above). Coronal computed tomography (CT) scan through the posterior subtalar joint. There is wide separation of the talar fragments. The degree of the subtalar joint dislocation and the marked comminution of the medial portion of the talus are evident.

$Talar body fracture, anteroposterior radiograph. ...$

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Media file 4: Talar body fracture, anteroposterior radiograph. This patient had a fall resulting in a pilon fracture of the tibia, a sagittally oriented fracture of the body of the talus, and a central compressive fracture of the calcaneus.

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$Talar body fracture, anteroposterior radiograph. ...$

Talar body fracture, anteroposterior radiograph. This patient had a fall resulting in a pilon fracture of the tibia, a sagittally oriented fracture of the body of the talus, and a central compressive fracture of the calcaneus.

$Talar body fracture, lateral radiograph (same pat...$

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Media file 5: Talar body fracture, lateral radiograph (same patient as in Image above). The fracture of the talus, existing purely in the sagittal plane, is not visible on the lateral radiograph. However, the central compressive calcaneal fracture is well visualized.

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$Talar body fracture, lateral radiograph (same pat...$

Talar body fracture, lateral radiograph (same patient as in Image above). The fracture of the talus, existing purely in the sagittal plane, is not visible on the lateral radiograph. However, the central compressive calcaneal fracture is well visualized.

$Lateral process fracture, anteroposterior radiogr...$

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Media file 6: Lateral process fracture, anteroposterior radiograph. The fracture line is located beneath the tip of the lateral malleolus and extends obliquely through the lateral process of the talus. LM=lateral malleolus, LP=lateral process of talus

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$Lateral process fracture, anteroposterior radiogr...$

Lateral process fracture, anteroposterior radiograph. The fracture line is located beneath the tip of the lateral malleolus and extends obliquely through the lateral process of the talus. LM=lateral malleolus, LP=lateral process of talus

$Lateral process fracture (same patient as in Imag...$

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Media file 7: Lateral process fracture (same patient as in Image 6). Axial computed tomography (CT) scan; the involvement of the subtalar joint is more easily seen on a CT scan.

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$Lateral process fracture (same patient as in Imag...$

Lateral process fracture (same patient as in Image 6). Axial computed tomography (CT) scan; the involvement of the subtalar joint is more easily seen on a CT scan.

$Patient OA. Lateral process of talus fracture, an...$

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Media file 8: Patient OA. Lateral process of talus fracture, anteroposterior radiograph. The fracture line (arrows) is nondisplaced and medially located at the junction of the lateral process and central body of the talus, making it difficult to see.

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$Patient OA. Lateral process of talus fracture, an...$

Patient OA. Lateral process of talus fracture, anteroposterior radiograph. The fracture line (arrows) is nondisplaced and medially located at the junction of the lateral process and central body of the talus, making it difficult to see.

$Patient OA. Lateral process of talus fracture, la...$

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Media file 9: Patient OA. Lateral process of talus fracture, lateral radiograph. The fracture line is better appreciated on this image, which isolates a triangular fragment at the tip of the lateral process of the talus.

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$Patient OA. Lateral process of talus fracture, la...$

Patient OA. Lateral process of talus fracture, lateral radiograph. The fracture line is better appreciated on this image, which isolates a triangular fragment at the tip of the lateral process of the talus.

$Patient OA. Lateral process of the talus fracture...$

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Media file 10: Patient OA. Lateral process of the talus fracture. Lateral view of technetium-99m (^99mTc) bone scan at 5 hours following injection. The fracture site shows a markedly increased uptake of radionuclide.

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$Patient OA. Lateral process of the talus fracture...$

Patient OA. Lateral process of the talus fracture. Lateral view of technetium-99m (^99mTc) bone scan at 5 hours following injection. The fracture site shows a markedly increased uptake of radionuclide.

$Patient OA. Lateral process fracture; sagittal, f...$

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Media file 11: Patient OA. Lateral process fracture; sagittal, fast spin-echo, inversion recovery magnetic resonance image. The tip of the lateral process shows high signal intensity consistent with edema. The magnetic resonance imaging (MRI) scan was performed several months after the fracture, and the fracture line has partially healed.

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$Patient OA. Lateral process fracture; sagittal, f...$

Patient OA. Lateral process fracture; sagittal, fast spin-echo, inversion recovery magnetic resonance image. The tip of the lateral process shows high signal intensity consistent with edema. The magnetic resonance imaging (MRI) scan was performed several months after the fracture, and the fracture line has partially healed.

$Posterior process fracture, lateral radiograph. T...$

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Media file 12: Posterior process fracture, lateral radiograph. The fracture is acute, which means that there is an absence of cortex around the posterior process fragment, clearly differentiating this from an os trigonum (see Image 13). Note also the ankle joint effusion and soft-tissue swelling adjacent to the fracture site.

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$Posterior process fracture, lateral radiograph. T...$

Posterior process fracture, lateral radiograph. The fracture is acute, which means that there is an absence of cortex around the posterior process fragment, clearly differentiating this from an os trigonum (see Image 13). Note also the ankle joint effusion and soft-tissue swelling adjacent to the fracture site.

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Media file 13: Os trigonum (OT), lateral radiograph. The ossicle is shaped like a smooth pebble and is well corticated.

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Os trigonum (OT), lateral radiograph. The ossicle is shaped like a smooth pebble and is well corticated.

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Media file 14: Fractures of the lateral and posterior processes of the talus, axial computed tomography (CT) scan. These fractures were associated with a talar body fracture.

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Fractures of the lateral and posterior processes of the talus, axial computed tomography (CT) scan. These fractures were associated with a talar body fracture.

$Stage 2A osteochondral fracture of the lateral ta...$

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Media file 15: Stage 2A osteochondral fracture of the lateral talar dome, anteroposterior radiograph. There is a semicircular subcortical lucency at the lateral aspect of the talar dome, and a slight cortical depression is present.

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$Stage 2A osteochondral fracture of the lateral ta...$

Stage 2A osteochondral fracture of the lateral talar dome, anteroposterior radiograph. There is a semicircular subcortical lucency at the lateral aspect of the talar dome, and a slight cortical depression is present.

$Stage 4 osteochondral fracture of the talar dome,...$

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Media file 16: Stage 4 osteochondral fracture of the talar dome, mortise radiograph. A small cortical fragment has become dislodged, leaving a small bony defect at the most lateral aspect of the talar dome.

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$Stage 4 osteochondral fracture of the talar dome,...$

Stage 4 osteochondral fracture of the talar dome, mortise radiograph. A small cortical fragment has become dislodged, leaving a small bony defect at the most lateral aspect of the talar dome.

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Media file 17: Axial computed tomography (CT) scan showing an osteochondral fracture lesion. On an axial image, the area of the osteochondral fracture is circular, and the density within it is heterogeneous.

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Axial computed tomography (CT) scan showing an osteochondral fracture lesion. On an axial image, the area of the osteochondral fracture is circular, and the density within it is heterogeneous.

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Media file 18: Patient BM. Coronal, T1-weighted magnetic resonance image of a stage 3 osteochondral fracture. A thin cortical fragment is seen; it is separated from the concave bony defect beneath it by intermediate–signal-intensity material. A stage 3 lesion is confirmed on T2-weighted and fast spin-echo, inversion recovery images.

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Patient BM. Coronal, T1-weighted magnetic resonance image of a stage 3 osteochondral fracture. A thin cortical fragment is seen; it is separated from the concave bony defect beneath it by intermediate–signal-intensity material. A stage 3 lesion is confirmed on T2-weighted and fast spin-echo, inversion recovery images.

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Media file 19: Patient BM. Coronal, fast spin-echo, T2-weighted magnetic resonance image with fat saturation, showing a stage 3 osteochondral fracture of the talar dome. A tiny cartilage defect is seen in the talar dome, showing the higher signal intensity of fluid compared to the intermediate signal intensity of cartilage. Fluid is also seen between the osteochondral fragment and adjacent bone, indicating that the fragment is detached but nondisplaced.

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Patient BM. Coronal, fast spin-echo, T2-weighted magnetic resonance image with fat saturation, showing a stage 3 osteochondral fracture of the talar dome. A tiny cartilage defect is seen in the talar dome, showing the higher signal intensity of fluid compared to the intermediate signal intensity of cartilage. Fluid is also seen between the osteochondral fragment and adjacent bone, indicating that the fragment is detached but nondisplaced.

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Media file 20: Patient BM. Sagittal, fast spin-echo, inversion recovery magnetic resonance image showing a stage 3 osteochondral fracture. On a fast spin-echo, inversion recovery image, the high–signal-intensity line around the osteochondral fragment is better seen.

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Patient BM. Sagittal, fast spin-echo, inversion recovery magnetic resonance image showing a stage 3 osteochondral fracture. On a fast spin-echo, inversion recovery image, the high–signal-intensity line around the osteochondral fragment is better seen.

$Hawkins type I fracture of the talar neck, latera...$

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Media file 21: Hawkins type I fracture of the talar neck, lateral radiograph. These fractures are quite subtle. Disruption of the dorsal cortex of the talar neck is visible, and the fracture line can be faintly followed vertically through the talar neck. Computed tomography (CT) scanning is useful to confirm the fracture.

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$Hawkins type I fracture of the talar neck, latera...$

Hawkins type I fracture of the talar neck, lateral radiograph. These fractures are quite subtle. Disruption of the dorsal cortex of the talar neck is visible, and the fracture line can be faintly followed vertically through the talar neck. Computed tomography (CT) scanning is useful to confirm the fracture.

$Hawkins type III fracture of the talar neck, late...$

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Media file 22: Hawkins type III fracture of the talar neck, lateral radiograph. The fracture of the talar neck is completely displaced dorsally. The posterior subtalar joint is dislocated, and the articular facet of the talus (arrows) is seen lying behind the articular facet of the calcaneus. The tibiotalar joint is subluxed.

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$Hawkins type III fracture of the talar neck, late...$

Hawkins type III fracture of the talar neck, lateral radiograph. The fracture of the talar neck is completely displaced dorsally. The posterior subtalar joint is dislocated, and the articular facet of the talus (arrows) is seen lying behind the articular facet of the calcaneus. The tibiotalar joint is subluxed.

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Media file 23: Avascular necrosis (AVN) of the talar body, lateral radiograph. The entire talar dome is sclerotic because of AVN, which occurred as a complication of a talar neck fracture.

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Avascular necrosis (AVN) of the talar body, lateral radiograph. The entire talar dome is sclerotic because of AVN, which occurred as a complication of a talar neck fracture.

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Media file 24: Partial Hawkins sign, anteroposterior radiograph. Following open reduction and internal fixation of a Hawkins type II fracture, a Hawkins sign (arrows), indicating intact vascularity, is seen over most of the talar dome. Laterally, however, the Hawkins sign is absent. The lateral portion of the dome is sclerotic, representing a small focus of avascular necrosis that has developed there.

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Partial Hawkins sign, anteroposterior radiograph. Following open reduction and internal fixation of a Hawkins type II fracture, a Hawkins sign (arrows), indicating intact vascularity, is seen over most of the talar dome. Laterally, however, the Hawkins sign is absent. The lateral portion of the dome is sclerotic, representing a small focus of avascular necrosis that has developed there.

$Medial fracture dislocation of the talonavicular ...$

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Media file 25: Medial fracture dislocation of the talonavicular joint, anteroposterior (AP) radiograph. On the AP radiograph, the medial dislocation of the talonavicular joint is evident. More difficult to see is the oblique fracture through the head of the talus.

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$Medial fracture dislocation of the talonavicular ...$

Medial fracture dislocation of the talonavicular joint, anteroposterior (AP) radiograph. On the AP radiograph, the medial dislocation of the talonavicular joint is evident. More difficult to see is the oblique fracture through the head of the talus.

$Lateral radiograph of a talonavicular fracture di...$

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Media file 26: Lateral radiograph of a talonavicular fracture dislocation.

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$Lateral radiograph of a talonavicular fracture di...$

Lateral radiograph of a talonavicular fracture dislocation.

More on Talus, Fractures

Overview: Talus, Fractures

Imaging: Talus, Fractures

Follow-up: Talus, Fractures

Multimedia: Talus, Fractures

References

Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. Jul 1970;52(5):991-1002. [Medline].
Hawkins LG. Fracture of the lateral process of the talus. J Bone Joint Surg Am. Sep 1965;47:1170-5. [Medline].
Tezval M, Dumont C, Stürmer KM. Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma. Sep 2007;21(8):538-43. [Medline].
Chan G, Sanders DW, Yuan X, Jenkinson RJ, Willits K. Clinical accuracy of imaging techniques for talar neck malunion. J Orthop Trauma. Jul 2008;22(6):415-8. [Medline].
Haverstock BD. Foot and ankle imaging in the athlete. Clin Podiatr Med Surg. Apr 2008;25(2):249-62, vi-vii. [Medline].
McCarthy CL, Wilson DJ, Coltman TP. Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging. Skeletal Radiol. Mar 2008;37(3):209-16. [Medline].
Thordarson DB, Kaku SK. Results of step-cut medial malleolar osteotomy. Foot Ankle Int. Dec 2006;27(12):1020-3. [Medline].
De Smet AA, Fisher DR, Burnstein MI, et al. Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients. AJR Am J Roentgenol. Mar 1990;154(3):555-8. [Medline]. [Full Text].
Yulish BS, Mulopulos GP, Goodfellow DB. MR imaging of osteochondral lesions of talus. J Comput Assist Tomogr. Mar-Apr 1987;11(2):296-301. [Medline].
Loomer R, Fisher C, Lloyd-Smith R. Osteochondral lesions of the talus. Am J Sports Med. Jan-Feb 1993;21(1):13-9. [Medline].
von Knoch F, Reckord U, von Knoch M, et al. Fracture of the lateral process of the talus in snowboarders. J Bone Joint Surg Br. Jun 2007;89(6):772-7. [Medline].
Sanders TG, Ptaszek AJ, Morrison WB. Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance. Skeletal Radiol. Apr 1999;28(4):236-9. [Medline].
Daniels TR, Smith JW. Talar neck fractures. Foot Ankle. May 1993;14(4):225-34. [Medline].
Ebraheim NA, Karkare N, Gehling DJ, et al. Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus. J Orthop Trauma. Sep 2007;21(8):579-82. [Medline].
He F, Huang H, Deng YM, Wang B, Zhang CQ, Zhao Z, et al. Application of spiral CT image 3D reconstruction in severe talar neck fracture. Chin J Traumatol. Feb 2007;10(1):18-22. [Medline].
Elias I, Zoga AC, Raikin SM, Peterson JR, Besser MP, Morrison WB, et al. Bone stress injury of the ankle in professional ballet dancers seen on MRI. BMC Musculoskelet Disord. Mar 28 2008;9:39. [Medline].
Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am. Sep 1959;41-A:988-1020. [Medline].
Cantrell MW, Tarquinio TA. Fracture of the lateral process of the talus. Orthopedics. Jan 2000;23(1):55-8. [Medline].
Crim JR, Cracchiolo A, Hall RL. Injuries of the foot. Imaging Foot Ankle. 1996;54-64.
Dipaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy. 1991;7(1):101-4. [Medline].
Higgins TF, Baumgaertner MR. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. Foot Ankle Int. Sep 1999;20(9):595-605. [Medline].

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Keywords

talus fracture, astragalus fracture, talar neck fracture, talar body fracture, talar head fracture, osteochondral fracture of the talar dome, transchondral fracture of the talar dome, osteochondritis dissecans

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Contributor Information and Disclosures

Author

Julia Crim, MD, Chief of Musculoskeletal Radiology, Professor, Department of Radiology, University of Utah
Julia Crim, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Amilcare Gentili, MD, Clinical Professor of Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Theodore E Keats, MD, Professor, Departments of Radiology and Orthopedics, University of Virginia School of Medicine
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Musculoskeletal

Talus, Fractures: Multimedia

Multimedia

Talar body fracture, anteroposterior radiograph. There is a sagittally oriented fracture through the body of the talus and disruption of the tibiotalar and subtalar joints. The injury was from a motor vehicle accident.

Talar body fracture, lateral radiograph (same patient as in Images above and below). There is a significant degree of comminution of the talar fracture, with comminuted fracture lines extending into the posterior and lateral processes of the talus.

Talar body fracture (same patient as in Images above). Coronal computed tomography (CT) scan through the posterior subtalar joint. There is wide separation of the talar fragments. The degree of the subtalar joint dislocation and the marked comminution of the medial portion of the talus are evident.

Talar body fracture, anteroposterior radiograph. This patient had a fall resulting in a pilon fracture of the tibia, a sagittally oriented fracture of the body of the talus, and a central compressive fracture of the calcaneus.

Talar body fracture, lateral radiograph (same patient as in Image above). The fracture of the talus, existing purely in the sagittal plane, is not visible on the lateral radiograph. However, the central compressive calcaneal fracture is well visualized.

Lateral process fracture, anteroposterior radiograph. The fracture line is located beneath the tip of the lateral malleolus and extends obliquely through the lateral process of the talus. LM=lateral malleolus, LP=lateral process of talus

Lateral process fracture (same patient as in Image 6). Axial computed tomography (CT) scan; the involvement of the subtalar joint is more easily seen on a CT scan.

Patient OA. Lateral process of talus fracture, anteroposterior radiograph. The fracture line (arrows) is nondisplaced and medially located at the junction of the lateral process and central body of the talus, making it difficult to see.

Patient OA. Lateral process of talus fracture, lateral radiograph. The fracture line is better appreciated on this image, which isolates a triangular fragment at the tip of the lateral process of the talus.

Patient OA. Lateral process of the talus fracture. Lateral view of technetium-99m (99mTc) bone scan at 5 hours following injection. The fracture site shows a markedly increased uptake of radionuclide.

Os trigonum (OT), lateral radiograph. The ossicle is shaped like a smooth pebble and is well corticated.

Fractures of the lateral and posterior processes of the talus, axial computed tomography (CT) scan. These fractures were associated with a talar body fracture.

Stage 2A osteochondral fracture of the lateral talar dome, anteroposterior radiograph. There is a semicircular subcortical lucency at the lateral aspect of the talar dome, and a slight cortical depression is present.

Stage 4 osteochondral fracture of the talar dome, mortise radiograph. A small cortical fragment has become dislodged, leaving a small bony defect at the most lateral aspect of the talar dome.

Axial computed tomography (CT) scan showing an osteochondral fracture lesion. On an axial image, the area of the osteochondral fracture is circular, and the density within it is heterogeneous.

Patient BM. Sagittal, fast spin-echo, inversion recovery magnetic resonance image showing a stage 3 osteochondral fracture. On a fast spin-echo, inversion recovery image, the high–signal-intensity line around the osteochondral fragment is better seen.

Avascular necrosis (AVN) of the talar body, lateral radiograph. The entire talar dome is sclerotic because of AVN, which occurred as a complication of a talar neck fracture.

Medial fracture dislocation of the talonavicular joint, anteroposterior (AP) radiograph. On the AP radiograph, the medial dislocation of the talonavicular joint is evident. More difficult to see is the oblique fracture through the head of the talus.

Lateral radiograph of a talonavicular fracture dislocation.

More on Talus, Fractures

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor

Patient OA. Lateral process of the talus fracture. Lateral view of technetium-99m (^99mTc) bone scan at 5 hours following injection. The fracture site shows a markedly increased uptake of radionuclide.