Talus fracture

　　The fractures of the talus bone are mostly caused by falling from a height and direct impact. The talus bone can fracture in a horizontal plane or form a longitudinal cleavage fracture. The fracture can appear linear, star-shaped, or粉碎性. Fractures of the talus bone often involve the ankle joint and subtalar joint, although the displacement is usually slight, it can lead to step-like deformities in the aforementioned joints, ultimately resulting in traumatic arthritis. Therefore, the prognosis of talus bone fractures is worse than that of talus neck fractures.

　　Talus fracture is less common, mostly caused by direct violence pressure injury or indirect compression injury from falling from a height. It is mainly manifested by local swelling, pain, subcutaneous ecchymosis, unable to stand and walk, etc. X-ray film can be diagnosed. The common complications of this disease are:

　　1. Ischemic necrosis: Talus fracture, due to the destruction of blood supply, is prone to non-union or avascular necrosis;

　　2. Chronic pain:Due to the destruction of the articular surface, it cannot be completely repaired, causing pain during walking and exercise;

　　3. Traumatic arthritis: Repeated wear causes wear of the articular surface, which eventually leads to traumatic arthritis.

　　Talus fracture is caused by traumatic factors, so attention should be paid to safety in production and life, and avoiding trauma is the key to preventing the disease. At the same time, it should be noted that active treatment should be carried out and debridement should be thorough to prevent infection and traumatic arthritis.

　　Talus fracture is relatively rare, mostly caused by external force impact, with poor prognosis. The necessary examinations include:

　　1. Inquire about the condition of the injury, including the cause, time, place, body posture at the time of injury, and which part landed first. If there is a wound or bleeding, the process of wound treatment should also be inquired, whether a tourniquet has been used and the time of using the tourniquet.

　　2. Comprehensive physical examination, pay attention to whether there is shock, soft tissue injury, bleeding, check the size, shape, depth and contamination of the wound. Whether there is exposure of the bone end, whether there is nerve, blood vessel, cranial brain, visceral injury and other fractures. For severely injured patients, it must be carried out quickly.

　　3. X-ray examination, in addition to the anteroposterior and lateral X-ray films, special position films should also be taken according to the condition of the injury, such as opening position (upper cervical injury), dynamic lateral position (cervical spine), axial position (navicular bone, calcaneus, etc.) and tangential position (patella) and so on. For complex pelvic fractures or those suspected of having intraspinal fractures, it is also advisable to perform tomography or CT examination according to circumstances.

　　In order to promote the early healing of the fractured bone after the talus fracture, it is first necessary to ensure the necessary nutrients for the growth of the broken bone in the diet. The requirements for diet vary at different stages after the fracture, what should be paid attention to in the diet after the fracture surgery?

　　Early stage (1-2 weeks)

　　The injured part has ecchymosis and swelling, meridians and collaterals are blocked, and Qi and blood are stagnant. During this period, treatment should focus on promoting blood circulation and removing blood stasis, and dissipating Qi. According to traditional Chinese medicine, 'if the blood stasis does not go away, the bone cannot grow' and 'if the blood stasis goes away, new bone will grow'. It can be seen that reducing swelling and removing blood stasis is the primary factor for fracture healing. Most of the early stage of fracture is the period of immobilization. At this time, it should be avoided to eat greasy bone soup and a large amount of meat that is difficult to digest, nor should excessive calcium be consumed. Diet should be easy to digest and absorb. Supplementation should be placed in the middle and late stages of fracture to play a role in nourishing. The principle of diet during the early stage of fracture should be light, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc. Avoid eating sour and spicy, dry and hot, and greasy foods, especially not to apply greasy tonifying foods such as bone soup, fatty chicken, braised water fish too early, otherwise blood stasis will accumulate and be difficult to dissipate, which will inevitably delay the course of the disease, slow down the growth of the callus, and affect the recovery of joint function in the future. At this stage, food therapy can use 10 grams of Panax notoginseng, 10 grams of Angelica sinensis, 1 pigeon, stewed until tender, and consume the soup and meat together. Take once a day, for 7-10 days consecutively. In the early stage of fracture, due to less movement and worry, Qi stagnation, and lack of strength to push and transport, constipation is common, especially in bedridden patients. Avoid eating foods that are easy to cause flatulence or indigestion, such as taro, taro, glutinous rice, etc., and eat more vegetables rich in fiber, and eat some bananas, honey, and other foods that promote defecation. If necessary, take laxative drugs such as 6-9 grams of Maren pill once or twice a day.

　　Middle stage (2-4 weeks)

　　Most of the ecchymosis has absorbed. During this period, treatment should focus on harmonizing the camp to relieve pain, removing blood stasis and promoting new growth, and joining bones and tendons. At this time, the callus begins to grow. After a period of bed rest, the body is in a state of high metabolism, with a significant loss of potassium, calcium, and other minerals. Diet should gradually shift from light to high-nutrient supplementation, actively consuming vitamins, calcium, potassium, zinc, and other trace elements to meet the needs of callus growth. The initial diet can be supplemented with bone soup, Cordyceps chicken stew, animal liver, etc., to provide more vitamin A, D, calcium, and protein. Food therapy can use 10 grams of Angelica sinensis, 15 grams of Chinese wolfberry, 15 grams of broken bone medicine, 10 grams of续断, 250 grams of fresh pork rib or beef rib, stewed for more than 1 hour, and consume the soup and meat together. Use for 2 weeks consecutively.

　　Late stage (more than 5 weeks)

　　After 5 weeks of injury, the ecchymosis at the fracture site has basically absorbed, and the callus has begun to grow, which is the late stage of fracture. Treatment should focus on tonifying, through nourishing the liver and kidney, and promoting the generation of a more solid callus, as well as relaxing the tendons and collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, restoring the past function. Diet can be unrestricted, and the recipe can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, braised water fish, etc. Those who can drink can choose Du Zhong broken bone tonifying wine, chicken blood vine wine, tiger bone papaya wine, etc. Food therapy can use 10 grams of Chinese wolfberry, 15 grams of broken bone medicine, 10 grams of续断, 50 grams of Job's tears. First, boil broken bone medicine and续断 to remove the dregs, then add the remaining two ingredients to cook porridge for eating. Take once a day, 7 days as one course. The interval between each course is 3-5 days, and 3-4 courses can be used.

　　For displaced fractures in this disease, open reduction is often required, and firm internal fixation with screws is used. It is generally believed that even if the fracture is reduced, it is not easy to achieve a good painless range of motion, so for comminuted fractures or when there are progressive ischemic necrosis signs, tibiocalcaneal and talocalcaneal joint fixation surgery can be performed. Common surgical methods include the following:

　　1. Internal Fixation

　　The fundamental method of preventing talus fracture ischemic necrosis is early surgery and strong and reliable internal fixation. If the fracture ends of the talus can be tightly compressed, the necrosis rate can be reduced by about 10%. For larger fracture fragments, mini-plate internal fixation can achieve good therapeutic effects.

　　2. Windowing Surgery

　　For smaller bone cartilage fragments that cannot be fixed, they should be thoroughly removed. The use of small Kirschner wires for windowing surgery at the injury site can promote the formation of fibrocartilage, which can allow the talus body to withstand greater pressure. The posterior medial injury of the talus can be completed by retrograde drilling across the talus.

　　3. Joint Arthrodesis

　　For severe comminuted talus fractures, no reduction or fixation method can be used. Some scholars advocate for a one-stage ankle arthrodesis. Joint arthrodesis can be chosen from talocalcaneal joint arthrodesis, tibiocalcaneal joint arthrodesis, Blair arthrodesis, talocalcaneal joint arthrodesis, and others. When severe talocalcaneal arthritis occurs, it is necessary to treat it with talocalcaneal joint arthrodesis or triple joint arthrodesis to prevent severe talocalcaneal arthritis after bone necrosis, which leads to functional impairment. For talus head fractures, if internal fixation is unstable or bone nonunion occurs after fixation, it may be considered to perform talocalcaneal joint arthrodesis.