Review Question - QID 8816

This patient has sustained a type II Hawkins fracture/dislocation of the talar neck. The most common complication is subtalar arthritis.

Talar neck fractures are the most common fractures of the talus. They are high-energy injuries which consist of a forced dorsiflexion and axial load to the ankle. They are classified by the Hawkins classification which may be seen in Illustration A. Long-term complications of talar neck fractures are (in order of decreasing frequency), subtalar arthritis, tibiotalar arthritis, osteonecrosis, and varus malunion. Illustration B details the complication rates following talar neck fractures by Hawkins grade.

Fortin et al. report that post-traumatic hindfoot arthrosis has been reported to occur in more than 90% of patients with displaced talar fractures. Salvage can be difficult in these situations and arthrodesis is usually necessary. They report that osteonecrosis is usually treated with arthrodesis. Varus malunion may be treated with talar neck osteotomy to restore medial neck length.

Halvorson et al. performed a systematic review of talar neck fractures. They found that post-traumatic arthrosis was the most common complication of this injury. The subtalar joint was found to be the most commonly affected followed by the tibiotalar joint, and finally the talonavicular joint.

Figure A demonstrates a Hawkins type II talar neck fracture/dislocation. Illustration A is a chart detailing the associated risks of avascular necrosis with the Hawkins classification. Illustration B lists the complications and their associated frequencies following talar neck fractures.

Incorrect Answers:
Answers 1, 2, 3, and 5 do not list the most common complication, which is subtalar arthritis.