Talar fractures

– require high energy – usually fall from a significant height or extreme dorsiflexion

– displaced fractures are a surgical emergency and need urgent Orthopaedic review due to the risk of avascular necrosis – think about the talus as the scaphoid of the ankle, but timely intervention is even more important

– it is very important to ensure that anatomic reduction is obtained with no rotation 0 it should ideally be dome in theatre

The Hawkins classification

Type I talar fractures: non-displaced fracture of the talar neck without dislocation

– risk of AVN: 10%

– treatment – short leg cast, foot in slight equinus position; can be managed as an outpatient but shoudl always be discussed with Orthopaedics prior to discharge

Type II talar fractures: displaced fracture of the talar neck with subluxation or dislocation of the subtalar joint due to destruction of the talocalcaneal ligament; the ankle remains aligned

– risk of AVN: 30%

– reduction should be performed in theatre

Type III talar fractures: displaced fracture of the talar neck with dislocation of the body of the talus from both the subtalar joint and the ankle joint; the body of the talus usually displaced postero-medially, in front of the Achilles tendon; can be associated with injuries to the posterior tibial artery and the tibialis nerve

– risk of AVN: 90%

– reduction should be performed in theatre

Type IV talar fractures:  talar neck fracture with dislocation of the head fragment and subtalar, tibiotalar, and talonavicular joint subluxation or dislocation

– risk of AVN: 100%

– “salvage treatment”, always in theatre

If you are interested to read more, here you can find a very good article covering the different types of talar fractures with drawings and Xrays.