Talar neck fracture.

Abstract

Despite advancement in the knowledge and understanding of talar neck fracture biomechanics and refined techniques of treatment, a significant number of patients with these fractures have long term complications. Anatomic reduction is the goal in all situations where possible. Careful follow-up of patients is mandatory to prevent unrecognized displacement of the fracture fragment as the swelling of the extremity subsides in the cast. Weight bearing should be delayed until radiographic union of the fracture is apparent, if possible. There is a tendency today towards increased use of open reduction and internal fixation of talar neck fractures. This more aggressive approach appears to give patients the best chance for healing without complications. The results of open reduction and internal fixation studies seem to show better maintenance of the fracture reduction, reduction of time until fracture union, and overall better long-term results. Careful assessment of tibiotalar, subtalar, and talonavicular joints is essential prior to any salvage procedure. The use of CT scans, MRI's, and plain tomograms seems to be of most help in assessment of these patients prior to arthrodesis or other salvage procedures. The incidence of poor results following talar neck fracture still continues to remain high, unfortunately, despite the advancement in the understanding and knowledge of these fractures.