Talushalsfraktur

Talar neck fractures extend through the thinnest cross-sectional portion of the talus, just proximal to the talar head. They represent one of the most common types of talus fracture (~30-50%), along with chip and avulsion fractures of the talus (~40-49%). These fractures are commonly associated with subtalar dislocation and/or posterior body fractures .

Pathology

Mechanism of injury

These fractures usually result from hyperdorsiflexion.

Radiographic features

Plain radiograph
  • Canale view (15 degree internal rotation with 15 degree, tube angle (similar tube angle to an AP foot)) demonstrates the fracture well
Classification

Hawkins classification :

  • type I: non displaced fracture
  • type II: displaced fracture with subluxation or dislocation of the subtalar joint and a normal ankle joint
  • type III: displaced fracture with body of talus dislocated from both subtalar and ankle joint

Canale and Kelly  described a rare type IV category which in addition to features described for type III there is dislocation or subluxation of the head of the talus at the talonavicular joint.

Treatment

Complications

  • hardware complications
    • loosening
    • backing out
    • hardware or peri-hardware fracture
  • tendon entrapment or injury
  • risk of avascular necrosis (AVN) increases with increasing classification type
    • type I fractures have 0%–15% risk
    • type II fractures have 20%–50% risk
    • type III fractures approach 100% risk
    • type IV fractures have 100% risk

History and etymology

The classification of talar neck fractures was described by Dr Leland G Hawkins in 1970 .

See also