Talar Neck Fractures

Talar neck fractures are relatively uncommon, but potentially devastating injuries with often life-altering sequelae. The talus is located in the hindfoot and permits pain-free motion of the ankle, subtalar, and transverse tarsal joints. Talar neck fractures are associated with high-energy mechanisms with severe soft tissue injury, bony comminution, and fracture displacement is common. Injury to the talar neck with resulting displacement can lead to permanent stiffness, deformity, and pain with hindfoot arthrosis estimated to occur in greater than 90% of displaced talar neck fractures. The uncommon nature of these injuries partially explains the paucity of high-quality literature to drive evidence-based treatment strategies. Displaced talar neck fractures almost exclusively receive treatment with open reduction internal fixation with nonoperative treatment reserved for the rare nondisplaced injury pattern or fractures in patients who are not surgical candidates. Classic complications following open fixation of talar neck fractures include osteonecrosis or avascular necrosis (AVN), posttraumatic arthritis, and malunion. The high-energy traumatic mechanism is often a feature in these injuries as well as fracture fragment displacement can disrupt the tenuous supply to the talus resulting in necrosis. Unrecognized comminution of the medial talar neck predisposes these injuries to malreduction leading to varus malunion deformity. Many of these injuries ultimately require hindfoot arthrodesis procedures for pain-relief regardless of the timing of fixation and quality of reduction. The high-energy mechanism of talar neck fractures also leads to significant soft tissue injury making surgical wound healing a considerable concern.