Talar Neck Fractures

  • Bo He
  • Michael Krosin


Talar neck fractures are a result of high-energy trauma causing extensive bony and soft tissue injury. Fractures with peritalar displacement, skin compromise, or neurovascular injury should be taken for immediate closed reduction to protect the surrounding soft tissue envelope. Timing of definitive fixation is more controversial, but staged surgeries have not been shown to adversely affect long-term outcomes. Dual anteromedial and anterolateral approaches are the gold standard for anatomic fracture reduction. Fixation of the neck involves multiple strategies including screw fixation, mini-fragment plating, or a combination of techniques. Care must be taken to avoid varus malreduction and shortening of the talus. The soft tissue envelope must be protected to minimize postoperative wound healing complications. Avascular necrosis (AVN) and post-traumatic arthritis are major sequelae that are difficult to treat if symptomatic and can ultimately lead to arthrodesis.


Talus Neck Fracture Fixation Technique 


  1. 1.
    Fortin PT, Balazsy JE. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001;9(2):114–27.CrossRefGoogle Scholar
  2. 2.
    Vallier HA, Nork SE, Barei DP, Benirschke SK, Sangeorzan BJ. Talar neck fractures: results and outcomes. J Bone Joint Surg Am Vol. 2004;86-a(8):1616–24.CrossRefGoogle Scholar
  3. 3.
    Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at the Hawkins classification for talar neck fractures: which features of injury and treatment are predictive of osteonecrosis? J Bone Joint Surg Am. 2014;96(3):192–7.CrossRefGoogle Scholar
  4. 4.
    Vallier HA. Fractures of the talus: state of the art. J Orthop Trauma. 2015;29(9):385–92.CrossRefGoogle Scholar
  5. 5.
    Beltran MJ, Mitchell PM, Collinge CA. Posterior to anteriorly directed screws for management of talar neck fractures. Foot Ankle Int. 2016;37(10):1130–6.CrossRefGoogle Scholar
  6. 6.
    Attiah M, Sanders DW, Valdivia G, Cooper I, Ferreira L, MacLeod MD, et al. Comminuted talar neck fractures: a mechanical comparison of fixation techniques. J Orthop Trauma. 2007;21(1):47–51.CrossRefGoogle Scholar
  7. 7.
    Charlson MD, Parks BG, Weber TG, Guyton GP. Comparison of plate and screw fixation and screw fixation alone in a comminuted talar neck fracture model. Foot Ankle Int. 2006;27(5):340–3.CrossRefGoogle Scholar
  8. 8.
    Capelle JH, Couch CG, Wells KM, Morris RP, Buford WL Jr, Merriman DJ, et al. Fixation strength of anteriorly inserted headless screws for talar neck fractures. Foot Ankle Int. 2013;34(7):1012–6.CrossRefGoogle Scholar
  9. 9.
    Karakasli A, Hapa O, Erduran M, Dincer C, Cecen B, Havitcioglu H. Mechanical comparison of headless screw fixation and locking plate fixation for talar neck fractures. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2015;54(5):905–9.CrossRefGoogle Scholar
  10. 10.
    Fleuriau Chateau PB, Brokaw DS, Jelen BA, Scheid DK, Weber TG. Plate fixation of talar neck fractures: preliminary review of a new technique in twenty-three patients. J Orthop Trauma. 2002;16(4):213–9.CrossRefGoogle Scholar
  11. 11.
    Maceroli MA, Wong C, Sanders RW, Ketz JP. Treatment of comminuted talar neck fractures with use of minifragment plating. J Orthop Trauma. 2016;30(10):572–8.CrossRefGoogle Scholar
  12. 12.
    Halvorson JJ, Winter SB, Teasdall RD, Scott AT. Talar neck fractures: a systematic review of the literature. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2013;52(1):56–61.CrossRefGoogle Scholar
  13. 13.
    Vints W, Matricali G, Geusens E, Nijs S, Hoekstra H. Long-term outcome after operative management of talus fractures. Foot Ankle Int. 2018;39(12):1432–43.CrossRefGoogle Scholar
  14. 14.
    Annappa R, Jhamaria NL, Dinesh KV, Devkant, Ramesh RH, Suresh PK. Functional and radiological outcomes of operative management of displaced talar neck fractures. Foot. 2015;25(3):127–30.CrossRefGoogle Scholar
  15. 15.
    Dodd A, Lefaivre KA. Outcomes of talar neck fractures: a systematic review and meta-analysis. J Orthop Trauma. 2015;29(5):210–5.CrossRefGoogle Scholar
  16. 16.
    Jordan RK, Bafna KR, Liu J, Ebraheim NA. Complications of talar neck fractures by Hawkins classification: a systematic review. J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg. 2017;56(4):817–21.CrossRefGoogle Scholar
  17. 17.
    Whitaker C, Turvey B, Illical EM. Current concepts in talar neck fracture management. Curr Rev Muscoskelet Med. 2018;11(3):456–74.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bo He
    • 1
  • Michael Krosin
    • 2
  1. 1.San Francisco Orthopaedic Residency ProgramSt Mary’s Medical CenterSan FranciscoUSA
  2. 2.Orthopaedic SurgeryHighland HospitalOaklandUSA

Personalised recommendations