Abstract
Fractures of the talar head are the most uncommon subset of talus fractures. Although rare, these injuries have the potential to cause substantial disability through alteration of the mechanics of the talonavicular joint, which can lead to chronic pain and abnormal gait. The mechanism of injury is either a compressive force of the midfoot against the talar head in a plantarflexed position or a shear force of the navicular against the medial talar head with the foot in an inverted position. Patients generally present with midfoot pain and an inability to bear weight. Radiographic evaluation of the talar head should include a Canale view for better visualization of the talar head and neck. CT scan is mandatory for surgical planning to determine the appropriate surgical approach and fixation strategy. Nondisplaced fractures can be managed nonoperatively in a cast. Indications for operative treatment include displacement, articular incongruity of the talonavicular joint, or instability of the talonavicular joint. Currently, there are no high-quality outcome studies to guide management of talar head fractures. The main complication of these injuries is talonavicular arthritis from a missed injury. An illustrative operative case example is presented at the end of the chapter to provide useful surgical techniques to treat these fractures. Overall, talar head fractures are significant articular injuries that should be treated aggressively to preserve the talonavicular joint with the goal of giving the patient the best chance to achieve a normal gait.