Talus is a very important and a small bone that is responsible for transferring weight of the body on the foot by articulating with the tibia and fibula. It functions as a connector between the foot and legs at the ankle joint. On above, it forms joint with fibula and tibia and it also communicates with other small cones of foot like calcaneus and navicular. As it bears the weight from the legs, excess load or repetitive strain on the talus can cause the fractures, which may be minute and tiny or wide and severe in some cases. The prolonged damage to talus usually results in slight hair like fractures and wide avulsion fractures are not common.

Symptoms of Talus bone fractures:

The major manifestations that suggest a fracture of talus bone are:

• Ankle pain which may be severe or mild
• Worsening of pain on movement
• Inability to stand normally
• Night aching after some days of fracture
• Pain on touching ankle region
• Redness on skin over ankle
• Swelling and inflammation

Causes of Talus fractures:

Main cause is maximum cases is the over stressing of the talus bone. The suggested causes for causing talus fracture may be:

• Excessive loading of talus
• Prolonged weight bearing activity
• Increased physical activity like running
• Changing the exercise patterns in case of athletes
• Sports strains like during playing football

How to diagnose a talus fracture?

Like any other foot bone fracture, usage of an imaging technique like x-rays, MRI, CT scan, a complete medical history and a physical examination of the foot are the methods to devise and confirm a diagnosis. Usually the medical history and physical examination are sufficient enough to make a diagnosis. X-rays may not reveal the tiny fractures of talus, so more advanced techniques like magnetic resonance imaging and computed tomography scan are used.

Treatment options for talus bone fractures:

The talus fracture can be treated either conventionally if fracture is minor or surgically if fractures are multiple and more complex.

Using the appropriate managing techniques, the healing process can be completed rapidly. The healing is good in most of the cases, as fractures are tiny and less time is required to heal them. Giving the foot complete rest, applying a cast is good enough. Plaster casting is not needed unless the normal cast and immobility don’t work fine.

The drugs taken in fractures are NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and pain killers like aspirin. The heavy doses of pain killers are not suggested and over the counter drugs do the work just fine.

If everything fails and pain continues after weeks of treatments, then surgery is performed to join the bone manually. This is known as the internal fixation of talus and a small cut is required for this procedure. The broken bone ends are brought together and joined with each other by using the wires, screws and small plates to provide extra support.

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St Mark James First Aid manual explains how brain has space between itself and the bone of the skull which allows it to move a little.

Causes often result from traffic incident, injuries during sporting activities, falls or blows to the head in a fight.

The impact does not necessarily have to be directly to the head. First Aid Training says indirect blows can still ‘rattle’ the brain in its shell due to the forces exerted.

Concussion is normally temporary, but does cause extensive disturbance of brain activity. This can cause impaired consciousness, usually only lasting a few minutes.

Further symptoms of concussion can include:

• dizziness or nausea upon recovery
• loss of memory of the event or the events prior to the injury
• mild, generalised headache

Concussion does not necessarily require medical attention, however the patient should be advised to seek medical assistance if they experience symptoms such as headache or blurred vision after the injury.

St Mark James Training says a first aider should treat the patient for the impaired consciousness. Their level of responsiveness should be monitored, along with their pulse and breathing. The patient should continue to be monitored even after they appear to have recovered as their level of responsiveness can deteriorate further in serious injures.

You should ensure that the patient has another responsible adult who can care for them and monitor them after they have recovered from the incident.

Any headache, nausea, vomiting or excessive sleepiness experienced after the initial head injury should be treated with concern and the patient should get medical advice. It is also precaution to check for a neck injury if the head has experienced an injury as advised by St Mark James Training.

There are other types of head injury that you may encounter.

Cerebral Compression will also produce a deteriorated level of consciousness, but may progress to unconsciousness. Other possible symptoms include:

• recent head injury
• intense headache
• noisy breathing, becoming slow
• slow, but full and strong pulse
• unequal pupil size
• weakness  or paralysis down one side of the face or body
• high temperature, flushed face
• drowsiness
• noticeable change in personality of behaviour, eg. irritability

A fracture of the skull is a serious injury and can be recognised by the following:

• wound or bruise on the head
• soft area or depression on the scalp
• bruising or swelling behind one ear
• loss of clear fluid or watery blood from the nose or ear
• blood in the white of the eye
• distortion or lack of symmetry in the head or face
• deteriorating level of response – may progress to unconsciousness

In both cerebral compression injuries and skull fractures, urgent

medical assistance is required. If you are in any doubt over a patient with a head injury, First Aid Classes say seek urgent medical advice as all head injuries are potentially serious.

REFERENCES

First Aid Manual (The Authorised Manual of St. John Ambulance, St Andrew’s Ambulance Association and the British St Mark James), 2006.

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Causes

When the ankle is stressed over its limit that it does not have the strength to bear any weight or pressure, an ankle injury may be the reason. Ankle fractures may be caused when a bone breaks and/or when the ligaments tear. Some of the common causes that may tear the ligaments of your joint include:

• Rolling or twisting your ankle
• Extending or flexing the joint too much
• Jumping from a high altitude

Symptoms

Some of the common signs and symptoms of ankle fractures include:

• Pain—sometimes you may not feel pain in the exact location of the fracture
• Swelling around the ankle
• Bruising—hemarthrosis—black or blue discoloration of the affected region
• Bone deformity around the ankle—the bone may be exposed
• Pale skin
• Numbness
• Inability to move the affected foot

Treatment

If you suspect that you may have fractured your foot, call emergency medical help. In the meantime, follow these steps:

1. Do NOT try to push back the protruding bone to its place. Simply cover the affected region with a sterile bandage or clean cloth
2. Stop the bleeding. Do this by applying direct pressure on the wounds with a clean cloth for about 15 minutes. Elevate the affected region, if possible and replace the cloth if the blood absorbs though
3. Control the swelling with RICE:

• Rest the ankle
• Ice the affected region
• Compress the affected region by wrapping it with an elastic bandage
• Elevate the affected  ankle above heart level

4. Control pain and inflammation. Take over-the-counter pain medicine such as aspirin or ibuprofen. Avoid giving aspirin to young children and teenagers under 18 years of age
5. If help has not arrived yet, ask a family member or friend to take you to the hospital immediately

Learn More

To learn more about bone, joint and ligament injuries and how to provide first aid for them enrol in St Mark James first aid and CPR training (more information).

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