If there is doubt about whether the fracture is truly non-displaced, a CT may be required. - Truly undisplaced fractures can be placed in a below-knee cast with ankle at 90 degrees and seen in fracture clinic within a week.These can have more displacement than is obvious on xray.ĩ. What is the usual ED management for this fracture? - Any talar neck fracture should be referred to the orthopaedics service at the time.Ideally this would take place in theatre if timely access is available. - Type 3 and 4 talar neck fractures (displaced with posterior fragment extruded backwards) need urgent reduction as the skin is at risk of necrosis, and closed reduction often fails.If closed reduction is unsuccessful, open reduction internal fixation may be required. - Displaced talar neck fractures require reduction by orthopaedics.When is reduction (non-operative or operative) required? - MRI is sometimes used in diagnosis of a suspected osteochondral fractureħ.- CT may be required either for operative planning or to assess whether a fracture is truly non-displaced.- 3 plain-film views of the ankle: AP, lateral and oblique.- There may be co-existing fractures or injuries in high-force mechanismsĥ. What radiological investigations should be ordered?.- Findings may be minimal in a non-displaced or osteochondral fracture, especially in ankle inversion injuries.- Pain and swelling just distal to the anterior aspect of the ankle.- Fractures of Talar neck and body occur with combination of dorsiflexion plus axial loading: eg falling from a height in crouching position or collision of go-cart with foot on brake pedal. ![]() - Uncommon injury, particularly in children.How common are they and how do they occur Hawkins Classification of Talar Neck fractures:ģ. - Displacement (Including presence of absence of subtalar subluxation.- Anatomical Location: Neck, Body, Lateral Process, or osteochondral fracture of the dome.This risk can be attenuated by appropriate early diagnosis and management. Talus fractures are uncommon injuries in children but are frequently associated with significant long-term disability due to the risk of avascular necrosis or osteoarthritis.
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