Reuben Notes


When describing fractures it is important to develop a pattern or system and be consistent using the system. This will help keep notes organized and consistent.



Type of fracture - spiral, oblique, transverse, comminuted

Open or closed fracture

Extra-articluare or intra-articular

Length - shortened or lengthened

Angulation - transverse plan or sagittal plane

Rotational - frontal plane - valgus or varus

Displacement - mild, moderate, severe

Location - epiphyseal, metaphyseal, diaphyseal

Alignment - anatomically, good, fair or poor

Direction of fracture line - medial or lateral, proximal or distal, dorsal or plantar

Talar Neck

Type I: Vertical fracture of the talar neck without displacement

  • disruption of 1 blood vessel
  • AVN risk 12%
  • Treatment: NWB short leg cast 6-8 wks. Take serial radiographs as it is important to see trabeculation across the fracture before starting weight bearing.

Type II: Vertical fracture of talar neck with dislocation of the talar body from the STJ

  • disruption of 2 blood vessels
  • AVN risk 42%
  • Treatment: Attempt closed reduction - push backwards on plantarflexed foot while pulling forward on the distal tibia. If successful percutaneous pin. If unsuccessful even after 1 attempt - ORIF

Type III: Vertical fracture of the neck of the talus, dislocation of the STJ and ankle

  • disruption of 2 blood vessels
  • AVN risk 91%
  • Treatment: ORIF

Type IV: Type III with addition displacement of the Talonavicular joint

  • disruption of 3 blood vessels
  • AVN risk 95%
  • Treatment: ORIF