Edited by Hayley Daniell and Matt Fury - 7/1/2021
Descriptors
Talar neck (Hawkins classification), lateral process, posterior process, head, body
Exam Pearls
Lower extremity neurovascular exam
Examine for skin threatening, open injuries
Examine foot for associated injuries
Workup
Radiographs: AP and lateral of the ankle and foot
Other imaging: CT ankle and foot
Labs: None
Other: Insert your text here
Management
Need for acute intervention:
Displaced talar neck fracture: Yes, emergent reduction and immobilization in ED
Nondisplaced talar neck fracture, talar head/body/process fracture: Immobilization without reduction
Weight-bearing and range of motion: NWB LE
Type of immobilization: AO short leg splint
Admission or discharge status: Admission for urgent OR if unable to reduce in ED; trauma waitlist for displaced talar neck fracture. Discharge with 1 week follow-up in trauma or F&A ankle clinic for non-operative fractures (see below)
Anticoagulation: ASA 325 daily
Antibiotics: None
Surgical Indications
Absolute: Inability to reduce in ED (urgent reduction in OR), displaced talar neck fracture (Hawkins II-IV)
Relative: Displaced (>2mm) talar head/body/lateral process/posteromedial process fracture
Not an indication: Nondisplaced talar neck fracture (Hawkins I) with no intra-articular stepoff on CT); nondisplaced talar head/body/process fractures