Emergent Care / Stabilization:
All cases of displaced talar neck fractures will require urgent closed reduction in the ED with a short leg splint.Causes / typical injury mechanism:
Talar neck fractures typically occur after forced hyper-dorsiflexion with axial load, usually caused by high-energy mechanisms such as a fall from a height, motor vehicle crashes, and airplane crashes. Classic history and presentation:
These injuries usually present with severe pain, swelling, inability to bear weight, and limited range of motion (ROM) of the ankle and subtalar joints. Prevalence:
- Age – Most commonly seen in patients aged 20-30 years.
- Sex / gender – More common in men than women.
Acute forced hyper-dorsiflexion of the talus against the anterior tibia.Grade / classification system:
- Hawkins I – nondisplaced
- Hawkins II – subtalar joint subluxation or dislocation
- Hawkins III – subtalar and tibiotalar joint subluxation or dislocation
- Hawkins IV – subtalar, tibiotalar, and talonavicular subluxation or dislocation
S92.113B – Displaced fracture of neck of unspecified talus, initial encounter for open fracture
S92.116A – Nondisplaced fracture of neck of unspecified talus, initial encounter for closed fracture
208685009 – Closed fracture talus, neck
208697005 – Open fracture talus, neck
Differential Diagnosis & Pitfalls
- Calcaneus fracture – May present with associated compression fractures of the lumbar spine and contralateral calcaneus.
- Lisfranc injury – May present with tenderness over the tarsometatarsal region and pain with pronation and abduction of midfoot. Pay attention to associated plantar ecchymosis on physical examination.