What is your diagnosis?

The patient is diagnosed with a talar neck fracture. These fractures are associated with high-impact mechanisms and account for nearly 50% of all talar fractures.[1] X-ray is a good initial imaging modality for these injuries, however CT should be considered to better assess the articulating surfaces of the talus.

• Pearl: To aid in viewing the talar neck, a Canale view can be used. The x-ray is taken with the ankle plantar flexed and pronated 15˚. The beam of the x-ray should be angled 75˚ from the horizontal plane where the foot lies.[2]

What is your management in the ED?

Management depends on the type of talar neck fracture. The most common classification system for talar neck fractures is the Hawkins-Canale classification:

• Type I fractures: nondisplaced fractures that usually only require splinting and non-weight bearing status. 

• Type II-IV fractures are displaced fractures with an associated dislocation that requires urgent reduction in the emergency department

• Type II fractures: talocalcaneal dislocation

• Type III fractures (Image 2): talocalcaneal and talotibial dislocations

• Type IV: all talar articulations disrupted.[3,4]

• Pearl: Most talar injuries are usually caused by forced hyperdorsiflexion of the ankle. They are often associated with other injuries in the patients and frequently present as an open fracture.[1] A detailed secondary survey and skin exam should be performed on all patients.

Image 2: Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 84976

What is your disposition? Do you consult orthopaedics emergently?