ICYMI: A Bad Pattern of Talar Neck Fractures to Watch Out For

These injuries may be seeing you — make sure you're seeing them

Smart Practice: Watch out for talar neck fractures that extend proximally into the talar body; they are badly behaved and are not well captured on the Hawkins classification.

What’s the Claim?

A retrospective, comparative study found that talar neck fractures with proximal extension into the talar body are more likely to:

  • Develop osteonecrosis (49% versus 19%), even after controlling for confounding variables like smoking and diabetes (odds ratio for AVN of 3.5 after controlling for those variables)
  • Collapse (14% versus 4%)
  • Progress to nonunion (26% versus 9%)

A sequence of visuals is presented at the bottom of this post,

How’s It Stack Up?

It’s surprising there isn’t more out there on this. Over 40% of the talar neck fractures in this study extended proximally. This pattern isn’t well captured by the Hawkins classification, and we’ve not seen a study specifically on this before, so we’ll share the author's exact words on how to diagnose it: