Talar neck fractures extend through the thinnest cross-sectional portion of the talus, just proximal to the talar head. They represent one of the most common types of talus fracture (~30-50%), along with chip and avulsion fractures of the talus (~40-49%). These fractures are commonly associated with subtalar dislocation and/or posterior body fractures 4.
Mechanism of injury
These fractures usually result from hyperdorsiflexion.
Hawkins classification 1:
- type I: non displaced fracture
- type II: displaced fracture with subluxation or dislocation of the subtalar joint and a normal ankle joint
- type III: displaced fracture with body of talus dislocated from both subtalar and ankle joint
Canale and Kelly 2 describes a rare type IV category which in addition to features describes in type III there is dislocation or subluxation of the head of the talus at the talonavicular joint.
- type I fractures: short leg cast or boot & no weight bearing
- type II-IV fractures: open reduction - internal fixation (ORIF)
- hardware complications
- backing out
- hardware or peri-hardware fracture
- tendon entrapment or injury
- risk of avascular necrosis (AVN) increase with increase in classification type
- type I fractures has 0%–15% risk
- type II fractures have 20%–50% risk
- type III fractures approach 100% risk
- type IV fractures have 100% risk
History and etymology
It was first described by L G Hawkins in 1970 1.
- 1. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970;52 (5): 991-1002. J Bone Joint Surg Am (link) - Pubmed citation
- 2. Canale ST, Kelly FB. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978;60 (2): 143-56. J Bone Joint Surg Am (link) - Pubmed citation
- 3. Tehranzadeh J, Stuffman E, Ross SD. Partial Hawkins sign in fractures of the talus: a report of three cases. AJR Am J Roentgenol. 2003;181 (6): 1559-63. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Berquist TH. Imaging of the Foot and Ankle. Lippincott Williams & Wilkins. (2012) ISBN:1451147996. Read it at Google Books - Find it at Amazon