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Injuries and Medical Advice

Broken Talus Bone

On rehabbing a busted talus, and how to avoid avascular necrosis.

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The best way to keep your talus from dying is ... not to break it! Illustration by Steve Graepel.So after nearly three decades of ice climbing, I finally got a little careless, screwed up and took a short groundfall catching one of my front points in the process and busting the neck of the talus bone in my right ankle, which is now held together with two screws. What can I expect in my first couple of months back on the rock? Do you have any recovery tips or cautions? In particular, any suggestions for minimizing risk of post-traumatic avascular necrosis?

—TLBZLAND/Rock and Ice Forum

I would say something derogatory about ice climbing but I will confine myself to: “Don’t play with knives,” and, “It’ll end in tears.”

Avascular necrosis (AVN) occurs when a fracture compromises blood supply to one part of the bone, and the bone laments its rotten luck at not having a
more comprehensive circulation, and then dies, causing much pain and possibly a market collapse.

You can avoid AVN of the talus by … not breaking your talus. Hang up your crampons since I am sure talus fractures are over represented in this
cohort. No fractured talus, no chance of post-traumatic AVN. Simples! Otherwise options are limited. Talk to God, who may have some ideas, though as
a purist she’s probably a boulderer.

The biggest factor influencing AVN is the severity of the fracture(s). More damage translates to a worse prognosis.

You may be able to negotiate to have the cast off a little early. Do it, even if it means signing your mother up for unnecessary hip replacements. Getting
the cast off will reduce the amount of joint stiffness that is related to immobilization and causes rehab times to blow out. Get yourself a good PT
who will pass you tissues instead of going easy.

What can you expect? A sore ankle and a foot that won’t conduct itself with such bravery anymore.

This article was published in Rock and Ice No. 214 (December 213).