Talar neck fracture
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.
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Pathology
Mechanism of injury
These fractures usually result from forced hyperdorsiflexion of the ankle with associated axial loading. There may be a rotational component with hindfoot supination and impact on the medial malleolus 6. Usually a result of high energy mechanisms. There is a 20-38% incidence of open injuries and 50% incidence of other associated injuries 6.
Radiographic features
Plain radiograph
- Canale view (15 degree internal rotation with 15 degree, tube angle (similar tube angle to an AP foot)) demonstrates the fracture well 5
CT
- useful adjunct to plain radiograph to identify subtle incongruities and assist with pre-operative planning
- undisplaced type I fractures may potentially be misclassified and the majority of talar neck fractures are not able to be classified according to the Hawkins classification 6
- the majority of apparent isolated talar neck fractures are actually talar body fractures with extension into the neck 6
Classification
Hawkins classification 1:
- type I: undisplaced fracture
- type II: displaced fracture with subluxation or dislocation of the subtalar joint and a normal ankle joint
- type III: displaced fracture with the body of talus dislocated from both subtalar and ankle joint
Canale and Kelly 2 described a rare type IV category which in addition to features described for type III there is dislocation or subluxation of the head of the talus at the talonavicular joint.
Treatment
- type I fractures: short leg cast or boot for 8 to 12 weeks, non-weight bearing for at least 6 weeks
- type II-IV fractures:
- initial management
- urgent closed reduction in the emergency department with CT to confirm the position and assist with pre-operative planning 6
- definitive management
- may require initial percutaneous pinning prior to definitive open reduction - internal fixation (ORIF) to allow adequate time for soft tissues to settle 6
- initial management
Complications
- hardware complications
- loosening
- backing out
- hardware or peri-hardware fracture
- infection
- tendon entrapment or injury
- risk of avascular necrosis (AVN) increases with increasing classification type
- type I fractures have a 0%–15% risk
- type II fractures have a 20%–50% risk
- type III fractures approach a 100% risk
- type IV fractures have a 100% risk
- post-traumatic arthritis 6
- subtalar (50%)
- tibiotalar (33%)
- mal-union 6
- varus mal-union (25-30%)
History and etymology
The classification of talar neck fractures was described by Dr Leland G Hawkins in 1970 1.
See also
Related Radiopaedia articles
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fracture
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- diaphyseal fracture
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- avulsion fracture
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facial fractures
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spinal fractures
- classification (AO Spine classification systems)
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cervical spine fracture classification systems
- AO classification of upper cervical injuries
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- Anderson and D'Alonzo classification (odontoid fracture)
- Roy-Camille classification (odontoid process fracture)
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cervical spine fracture classification systems
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upper limb fractures
- classification
- Rockwood classification (acromioclavicular joint injury)
- AO classification (clavicle fracture)
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- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- AO/OTA classification of distal humeral fractures
- Milch classification (lateral humeral condyle fracture)
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- Mason classification (radial head fracture)
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scapular fracture
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- proximal humeral fracture
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- arm
- elbow
- forearm
- wrist
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carpal bones
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- capitate fracture
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- lower limb fractures
- classification by region
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- Pipkin classification (femoral head fracture)
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- American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)
- Cooke and Newman classification (periprosthetic hip fracture)
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- ankle
- foot
- Berndt and Harty classification (osteochondral lesions of the talus)
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- Myerson classification (Lisfranc injury)
- Nunley-Vertullo classification (Lisfranc injury)
- pelvis and lower limb fractures by region
- pelvic fracture
- sacral fracture
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hip
- acetabular fracture
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femoral neck fracture
- subcapital fracture
- transcervical fracture
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trochanteric fracture
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- posterior cruciate ligament avulsion fracture
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- Maisonneuve fracture
- ankle
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- tarsal bones
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