距骨骨折,Talus Fracture,.,Anatomy,The tortoise,Blood supply,Te contribution of the blood supply to the talus was 16.9% for the peroneal artery, 36.2% for the anterior tibial artery, and 47.0% for the posterior tibial artery,X-ray Canale 位,X-ray Broden 位一般用于术中评估。,The type of talus fracture,Talar neck fracture (50%, 1% of ankle fracture) Corpora tali fracture （25%） Talar head fracture Lateral process of talus fracture（雪橇踝） Posterior process of talus fracture（外突-牧羊人骨折， 内突-Cedell骨折）,1.TALAR HEAD FRACTURES,Fractures of the head of the talus have been reported to constitute 5% to 10% of talar injuries. Axially directed loading and compression of the talar head and A dorsal compression fracture of the anterior tibial plafond. Recognition of this fracture can be difcult,Treatment,A dorsal incision. Fixation can be placed directly or percutaneously from the medial side as needed . Te reported rate of osteonecrosis of this segment of the head is 10%, and if degenerative arthrosis occurs, talonavicular arthrodesis may be indicated.,2.TALAR NECK FRACTURES,In 1919, Anderson, having observed 18 patients with talar injuries in the Royal Flying Corps, coined the term aviators astragalus. In 1952, Coltart reviewed 25,000 fractures sustained during World War II. He found 228 talar fractures, 106 of which were classifed as talar neck fractures. He reported osteonecrosis rates of 35% with subtalar dislocation and 95% with ankle and subtalar dislocation.,In 1970, Hawkins published a landmark paper on the results of 57 talar neck fractures in 55 patients. In 1978，Canale and Kelly at this clinic clinically and radiographically reviewed 71 fractures of the neck of the talus in 70 patients with an average follow-up of 12.7 years. They named a type IV fracture .,HAWKINA Classification,1.距骨颈无或轻度移位骨折 2.距骨颈+距下关节 3.距骨颈+距下关节+胫距关节 4.距骨颈+距下+胫距+距舟关节,HAWKINA Classification,In nondisplaced vertical fractures of the neck (group I fractures), osteonecrosis did not occur and all fractures united. All displaced fractures with subluxation or dislocation of the subtalar joint (group II fractures) united, although osteonecrosis subsequently developed in 42%. In fractures with dislocation of the subtalar and the ankle joints (group III fractures), nonunion occurred in 11% and osteonecrosis developed in 91%. An increasing percentage of fair and poor results (75%) was noted in group III fractures compared with group II fractures. The presence of osteonecrosis also correlated with fair or poor results (88%).,TREATMENT,TYPE I FRACTURES CT scans and evaluate the stability of subtalar joint. the fracture should be immobilized in a belowknee cast for 8 to 12 weeks, with weight bearing delayed until trabeculation across the fracture is seen.,TYPES II, III, AND IV FRACTURES,Prompt ORIF Type III and type IV fractures constitute an orthopaedic emergency.,TALAR BODY FRACTURES,Sneppen et al. classifed talar body fractures into fve major types based on anatomic location: type I, osteochondral or transchondral; type II, coronal-sagittal, horizontal, noncomminuted, shear; type III, posterior tubercle; type IV,lateral process; type V, crush.,Posttraumatic Arthritis,Not all patients with osteonecrosis are symptomatic, especially if collapse does not occur. The rate of posttraumatic arthritis varied from 36% to 94% and again was more common in patients with comminuted and open fractures. Approximately 17% to 44% of patients require secondary surgery, usually for posttraumatic arthritis or malalignment.,1970年，Hawkins观察到了在距骨骨折术后6-8周在距骨穹隆处部分患者可出现透亮线，这透亮线后来被命名为“Hawkins征”，并被认为是距骨不出现缺血坏死的可喜现象。,