These neck fractures are rare but potentially life-threatening injuries that often reverse life. However, Talar neck fractures are associated with high energy levels, with severe soft tissue injuries, bone fractures, and fracture-dislocations common. Talar neck injury and the result of migration can lead to permanent stiffness, paralysis, and pain, with hindfoot arthrosis estimated to occur in more than 90% of talar neck fractures.
Anatomy of a talus
The talus is divided into three regions: the head, the neck, and the body. The talus has no muscle attachment and more than half of the talus is covered with articular cartilage. As a result, the talus acts as a keystone in many complex expressions with the tibia superior, the lower calcaneus, and the navicular anteriorly. The medial and lateral extensions of the upper talar articular are also associated with their ankle malleoli. The upper part of the posterior malleolus also speaks to the posterior process of the talus.
What is a talar neck?
The talar neck is the medium angle (10-44 °) and plantar (5-50 °) relative to the body. The neck is virtually devoid of articular cartilage. Traditionally, the significance of the neck is not only that it is the building link between the head and the body, but also that it is the process of regenerating talar blood. However, a recent MRI cadaveric study of advanced gadolinium showed strong antegrade blood supply, which may lead to the fact that not all talar neck fractures progress to osteonecrosis.
Osteology of the talar neck
The osteology of the talar neck is also unique, as it has less trabecular bone than the head or body, and the trabeculae are in a different orientation than the body. Although the trabecular bone in the talar body is in a similar way to the transfer of body weight, transferring body weight from plafond to foot, there is a rapid change towards trabeculae at the junction of the talar body and neck, making the talar neck vulnerable to fracture.
However, The old described method of talar neck fracture is forcing the ankle dorsiflexion to be attached to the axial loading. However, most injuries include a rotating part which causes the talar neck to have an effect on the medial malleolus. This causes the onset of the dorsomedial talar neck and the speculation of the talar neck falling into varus and the discomfort of the extension. Moderate malleolar fractures can also occur in 28% of patients.
What can we do to help?
If a talar neck fracture is not isolated and all joints are properly aligned, then ineffective treatment is a wise decision. The patient should understand the importance of complying with weight loss.
However, if this fracture is part of the talar neck injury-induced migration, which needs to be reduced, there may be additional decisions to be made regarding the investigation and the types of treatment.
Plain x-rays may be all that is needed if the fracture is not removed. However, this is not uncommon as most of the talar neck breaks at least with some migration.
CT scans are very helpful whenever there is any question about migration or the need for subtalar joint dislocation. Along with a number of injuries, increased migration suggests the presence of subtalar and tibiotalar osteochondral injuries. This often requires surgical procedures to remove and repair these fractures.
The current understanding is that the risk of osteonecrosis is related to the rate of migration at the time of injury. The important difference is that although delayed repairs are acceptable, delayed reduction reductions are not acceptable. However, keep in mind that You may also face military neck(cervical kyphosis) due to talar neck fracture.
What is a military neck?
The military neck is an unusual curve of the cervical spine that makes it look like it "stands up." The condition is called cervical kyphosis. However, common causes include:
Degenerative disc disease.
Cervical kyphosis can mean that your neck is unusually straight or bent backward. However, people with military necks have unusually straight necks. It is a random word for cervical spine deformity which causes irregular curves in your spine. Also, It has nothing to do with the military. Both children and adults can get cervical kyphosis. There are several causes for this condition.
The most common symptom of the military neck is pain. When the bones are weakened and the spine is bent, you put more pressure on the spine, which can cause more pain. However, there are many treatments available that you can do better with.
How can we treat a military neck?
Some of the most common treatments are physical therapy, neck braces, and painkillers. Unless the neck curve compresses the spine, for which a doctor may recommend surgery. However, The most common surgery for cervical kyphosis is spinal manipulation.
For at-home treatments, your doctor or physical therapist may recommend that you do the following:
Relax your neck. Avoid activities that make your neck stiff.
Chin tuck. Doing chin tucks at home may also help heal your condition.
Straighten your neck. A special contour pillow can help to properly position your neck while you sleep; slide the inside of your pillowcase to support the curve of your neck. Your provider may also recommend using certain positions to help reduce arm pain that comes out of your neck.
Apply ice. Ice packs and ice bags can help alleviate pain. Your doctor or physical therapist will probably suggest using the ice for 10 to 15 minutes at a time. You can also massage the area by rubbing an ice cup or ice cube on the sore spot.
Apply heat. A heating pad, hot pack, or hot bath or shower can all be beneficial. Heat often works best when applied for 15 to 20 minutes at a time.
What causes a military neck?
The most common cause of military neck is poor posture, either when awake or when sleeping. Poor posture can result from staring at the computer, occupational conditions, or repetitive movements. However, the condition can develop from other factors as well, such as:
Degenerative disc disease
As you grow older, your intervertebral discs begin to deteriorate. This causes the discs in your spine to grow thin and fall off.
However, This change in the spine can change the natural bend of your neck and cause imbalance due to the weight of your head. This disease usually progresses with difficulty as you grow older.
The military neck can be iatrogenic, which means it is an unintended consequence of a medical procedure. The most common of these procedures is a laminectomy, which is performed to relieve stress on the spine.
However, removing the lamina creates more nerve space, but can also cause facet joints between the vertebrae to become unstable. This problem is more common in children undergoing surgery, compared with adults. Iatrogenic disorders may also result from ineffective cervical spinal cord injury, in which case the connection is too short.
This condition is a type of arthritis of the neck. As your discs deteriorate with increasing age, your bones begin to rub against each other and break down. This causes the spine to bend, your head tilted forward, and your neck bent. However, Deterioration of the discs can also lead to arthritis.
Treatment of talar neck fracture:
A broken talar neck fracture is likely to receive treatment with open reduction and internal correction with non-invasive treatment set for a pattern of irregular injuries or fractures in non-surgical patients.
Non-surgical treatment involves wrapping the splint in a critical condition, and changing the short leg once the swelling is gone. Surgical options for talar neck fracture include external correction or an internal correction for open reduction. However, the goal of surgery is to reduce anatomy, which can be a challenge in cases of high mobility, alteration, or trauma. Biomechanical studies have shown that a small 2 mm malfunction of the articular surface alters the contact pressures.
However, Consideration of soft tissue, type of fracture, and other associated injuries often refers to a specific surgical procedure. There are various reports of the screw, plate, and hybrid repair techniques. Historically, talar neck fractures have been treated promptly with open fractures or severity. The theory was that rapid reduction and correction resulted in permanent blood supply to the talus. New books have provided conflicting results.