SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Talar neck fracture
Other Resources UpToDate PubMed

Talar neck fracture

Contributors: Adwin Denasty MD, Benedict F. DiGiovanni MD, FAOA, FAAOS
Other Resources UpToDate PubMed


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.

  • Age – Most commonly seen in patients aged 20-30 years.
  • Sex / gender – More common in men than women.
Risk factors: High-energy trauma.

Pathophysiology: Acute forced hyper-dorsiflexion of the talus against the anterior tibia.

Grade / classification system: Hawkins classification
  • 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

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

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.

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed:05/08/2023
Last Updated:05/17/2023
Copyright © 2023 VisualDx®. All rights reserved.
Talar neck fracture
Copyright © 2023 VisualDx®. All rights reserved.