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.
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
