Talar Neck Fractures

Author: Brian Weatherford

Topic updated on 01/08/13 6:16pm

Introduction

Epidemiology
- most common fracture of talus ( 50%)
Mechanism
- a high-energy injury
- is forced dorsiflexion with axial load
Associated conditions
- ipsilateral lower extremity fractures common

Anatomy

Articulation
- inferior surface articulates with posterior facet of calcaneus
- talar head
  articulates with
  - navicular bone
  - sustenaculum tali
- lateral process articulates with
  - posterior facet of calcaneus
  - lateral maleolus of fibula
- posterior process consist of medial and lateral tubercles separated by groove for FHL
Blood supply
- talar neck supplied by three sources
  - posterior tibial artery
    - via artery of tarsal canal (dominant supply)
      - supplies majority of talar body
    - deltoid branch of posterior tibial artery
      - supplies medial portion of talar body
      - may be only remaining blood supply with a displaced fracture
  - anterior tibial artery
    - suplies head and neck
  - perforating peroneal artery via artery of tarsal sinus
    - suplies head and neck

Classification

Hawkins Classification
Type	Description	AVN	Images
Hawkins I	Nondisplaced	0-13% AVN
Hawkins II	Subtalar dislocation	20-50%
Hawkins III	Subtalar and tibiotalar dislocation	20-100%
Hawkins IV	Subtalar, tibiotalar, and talonavicular dislocation	70-100%

Imaging

Radiographs
- recommended views
  - AP and lateral
  - Canale View
    - optimal view of talar neck
    - technique is maximum equinus, 15 degrees pronated, Xray 75 degrees cephalad from horizontal
CT scan
- best study to determine degree of displacement, comminution and articular congruity
- CT scan also will assess for ipsilateral foot injuries (up to 89% incidence)

Treatment

Nonoperative
- emergent reduction in ER
  - indications
    - all cases require emergent closed reduction in ER
- short leg cast for 8-12 weeks (NWB for first 6 weeks)
  - indications
    - nondisplaced fractures (Hawkins I)
  - CT to confirm nondisplaced without articular stepoff
Operative
- urgent open reduction and internal fixation
  - indications
    - all displaced fractures (Hawkins II-IV)

Techniques

ORIF
- approach
  - two approaches recommended
    - visualize medial and lateral neck to assess reduction
    - typical areas of comminution are dorsal and medial
  - anteromedial
    - between tibialis anterior and posterior tibialis
    - preserve soft tissue attachments, especially deep deltoid ligament
  - anterolateral
    - between tibia and fibula proximally, in line with 4th ray
    - elevate extensor digitorum brevis and remove debris from subtalar joint
- technique
  - anatomic reduction essential
  - variety of implants used including mini and small fragment screws, cannulated screws and mini fragment plates
  - medial to lateral lag screws may be used in simple fracture patterns
  - consider mini fragment plates in comminuted fractures to buttress against varus collapse
- postoperative
  - non-weight-bearing for 10-12 weeks

Complications

Osteonecrosis
- radiographs
  - hawkins sign
    - subchondral lucency best seen on mortise Xray at 6-8 weeks
    - indicates intact vascularity with resorption of subchondral bone
  - associated with talar neck comminution and open fractures
Posttraumatic arthritis
- subtalar arthritis (50%)
  - most common complication
- tibiotalar arthritis (33%)
Varus malunion (25-30%)
- can be prevented by anatomic reduction
- treatment includes medial opening wedge osteotomy of talar neck
- leads to
  - decreased subtalar eversion
    - decreased motion with locked midfoot and hindfoot
  - weight bearing on the lateral border of the foot

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Qbank (8 Questions)

TAG

(OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figures A and B. A clinical photo of the patient at the time of follow-up is seen in Figure C. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. Physical exam is notable for ambulation on the lateral border of the foot with hindfoot varus, midfoot supination and diminished subtalar motion compared with the contralateral side. Which of the following is an option for reconstruction of this patient's deformity? Topic

Review Topic

FIGURES: A

1. Total ankle arthroplasty
2. Lateral calcaneus closing wedge osteotomy
3. Calcaneal neck opening wedge osteotomy
4. Talar neck opening medial wedge osteotomy
5. Triple arthrodesis

PREFERRED RESPONSE ▶

DISCUSSION: The most common position of talar neck malunion is varus and this deformity can lock the subtalar and transverse tarsal joints leading to diminished motion and ultimately subtalar arthrosis. Medial opening wedge osteotomy of the talar neck has been described to restore the anatomy of the talus and preserve hindfoot motion.

Daniels et al performed a biomechanical study of hindfoot motion following medial osteotomy and varus malalignment of the talar neck. The authors found a direct correlation between the degree of varus malalignment and dimished forefoot and subtalar motion, and caution against compressive fixation of the medial talus in the presence of comminution.

Monroe and Manoli present a case report of talar neck malunion and describe their technique for osteotomy of the talar neck with insertion of a tricortical iliac crest bone graft to correct the deformity. They found a significant improvent in the AOFAS ankle-hindfoot score and no evidence of osteonecrosis with follow-up greater than 4 years.

Huang and Cheng retrospectively review their results with anatomic reconstruction of the talar neck in 9 patients who presented a minimun of four weeks after the initial injury with a malreduced or neglected talar neck fracture. They found favorable outcomes with delayed reconstruction as determined by the AOFAS ankle-hindfoot score at an average follow up of 53 months, however note that six patients subsequently developed radiographic hindfoot arthrosis.

Incorrect Answers:
Answer 1: Total ankle arthroplasty is reserved for patients with end-stage tibiotalar arthritis. This patient has an intact and functional tibiotalar joint
Answer 2: Lateral calcaneus closing wedge osteotomy would correct some hindfoot varus, however would not address the talar neck deformity leading to diminished motion.
Answer 3: Calcaneal neck opening wedge osteotomy would exacerbate the patient's deformity
Answer 5: Triple arthrodesis would be not be a viable option in a patient with a preserved tibiotalar and subtalar joint.

REFERENCES:

1. Daniels TR, Smith JW, Ross TI. Varus malalignment of the talar neck. Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am. 1996 Oct;78(10):1559-67. PMID:8876585 (Link to Abstract)

2. Monroe MT, Manoli A 2nd. Osteotomy for malunion of a talar neck fracture: a case report. Foot Ankle Int. 1999 Mar;20(3):192-5. PubMed PMID: 10195299 PMID:10195299 (Link to Abstract)

3. Huang PJ, Cheng YM. Delayed surgical treatment for neglected or mal-reduced talar fractures. Int Orthop. 2005 Oct;29(5):326-9. Epub 2005 Aug 11 PMID:16094539 (Link to Abstract)

Question Authors:

Brian Weatherford MD, Ben Taylor MD, John Badylak MD,

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TAG

(OBQ09.207) Varus malalignment after a talar neck fracture with medial comminution causes a decrease in what motion? Topic

Review Topic

1. Tibiotalar dorsiflexion
2. Tibiotalar plantarflexion
3. Subtalar eversion
4. Subtalar inversion
5. Internal rotation

PREFERRED RESPONSE ▶

DISCUSSION: Varus alignment at the talar neck results in a decrease in subtalar eversion before impingement occurs. Varus talar neck alignment can cause a fixed internal rotation position of the midfoot as the navicular follows the talar head. This can lead to a more rigid hindfoot which is specifically manifested as a decreased eversion range of motion.

Herscovici et al review the appropriate management of complex ankle and hindfoot injuries in this instructional course lecture.

Daniels et al performed a cadaveric study where they osteotomized the talar neck and then studied ankle motion with and without removal of a medially based wedge of bone. They found that subtalar eversion was specifically decreased.

Sanders et al found that secondary reconstructive procedures following talar neck fractures were most commonly performed to treat subtalar arthritis or misalignment.

REFERENCES:

1. Daniels TR, Smith JW, Ross TI: Varus malalignment of the talar neck: Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am 1996;78:1559-1567 PMID:8876585 (Link to Abstract)

2. Herscovici D Jr, Anglen JO, Archdeacon M, et al: Avoiding complications in the treatment of pronation-external rotation ankle fractures, syndesmotic injuries, and talar neck fractures. J Bone Joint Surg Am 2008;90:898-908 PMID:18381329 (Link to Abstract)

3. Sanders DW, Busam M, Hattwick E, et al: Functional outcomes following displaced talar neck fractures. J Orthop Trauma 2004;18:265-270 PMID:15105747 (Link to Abstract)

Question Authors:

John Badylak MD, Michael Hughes MD,

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TAG

(OBQ08.234) A 30-year-old patient underwent open reduction internal fixation of a talar neck fracture 8 weeks ago. His current radiographs demonstrate a subchondral radiolucency of the dome of the talus. What is the next most appropriate course of action? Topic

Review Topic

1. Injection of bone cement into the talus to prevent further avascular necrosis
2. Ankle fusion
3. Subtalar fusion
4. Ankle arthroscopy to address this osteochondral lesion
5. Continued observation as the vascularity to the talus is intact

PREFERRED RESPONSE ▶

DISCUSSION: A subchondral radiolucency of the talar dome after a talar neck fracture is known as the "Hawkins sign" and is a well-described radiographic indication of viability of the talar body. Rockwood and Green state "by the 6th-8th week, if the patient has been non-weight-bearing, diffuse atrophy is evident by radiographs. An AP radiograph of the ankle reveals the presence or absence of subchondral atrophy in the dome of the talus. Subchondral atrophy excludes the diagnosis of avascular necrosis." Tezval et al in a retrospective review showed that a subchondral lucency seen on the AP radiograph was a good indicator of talus vascularity following fracture. They state it is unlikely that AVN will develop at a later stage after injury if a Hawkins sign was present. Illustration A shows the characteristic appearance of a Hawkins sign and subchondral sclerosis.

Illustrations: A

REFERENCES:

1. Heckman JD: Fractures of the talus, in Bucholz RW, Heckman JD (eds): Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 2091-2132

2. Tezval M, Dumont C, Sturmer KM: Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma 2007;21:538-543 PMID:17805020 (Link to Abstract)

Question Authors:

Greg Galano MD, Patrick McCulloch MD, Patrick McCulloch MD,

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TAG

(OBQ05.95) A 29-year-old male sustains the isolated lower extremity injury shown in Figure A. During open reduction, what structure must be kept intact in order to protect the remaining blood supply to the talar body? Topic

Review Topic

FIGURES: A

1. Medial malleolus
2. Deltoid ligament
3. Anterior talofibular ligament
4. Lateral malleolus
5. Calcaneonavicular ligament

PREFERRED RESPONSE ▶

DISCUSSION: Figure A represents a type 3 Hawkins talar neck fracture. A type 3 injury is defined as a displaced fracture of the talar neck with dislocation of body of talus from both the subtalar joint and the tibiotalar joint. In these injuries, the talar body fragment typically rotates around intact deltoid ligament fibers to lie in soft tissues with the fracture surface pointing laterally and cephalad. Often, the deltoid branch of the posterior tibial artery, which lies between the leaves of the deltoid ligament and supplies up to 1/2 of the medial talar body, is the only remaining blood supply. Therefore, the deltoid ligament must be preserved to lower the risk of avascular necrosis. When performing a medial malleolar osteotomy, the deltoid ligament must remain in continuity with the malleolus to prevent disruption of the blood supply.

The review article by Fortin et al discusses talar blood supply, injury mechanisms and classifications, and treatment options. They state that main artery to the body of the talus is the artery of the tarsal canal, which is a branch of the posterior tibial artery. The peroneal and anterior tibial artery also contribute branches to the talus.

Illustration A and B show the arterial network of the talus.

Illustrations: A

REFERENCES:

1. Richardson EG (ed): Orthopaedic Knowledge Update: Foot and Ankle 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 35-46.

2. Sarrafian SK: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional Philadelphia, PA, JB Lippincott, 1983.

3. Fortin PT, Balazsy JE. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001 Mar-Apr;9(2):114-27. PMID:11281635 (Link to Abstract)

Question Authors:

Joshua Blomberg MD, Ben Taylor MD, Jan Szatkowski MD,

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TAG

(OBQ04.44) A 34-year-old female is involved in a motorcycle crash. She sustains a talus fracture with associated dislocation of the subtalar joint and maintained congruence of the tibiotalar and talonavicular joints as shown in Figure A. The fracture has healed and she now has symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion. What is the most likely deformity causing these symptoms? Topic

Review Topic

FIGURES: A

1. Combined varus and plantar malunion
2. Isolated varus malunion
3. Isolated valgus malunion
4. Isolated dorsal malunion
5. Isolated plantar malunion

PREFERRED RESPONSE ▶

DISCUSSION: Figure A displays a Hawkins Type 2 talar neck fracture. (Hawkins classification shown in Illustration A). Malunion after inaccurate reduction of talar neck fractures has a reported incidence as high as 32%, with varus malunion occurring most frequently. Dorsal malunion can occur when the body is not properly derotated during reduction and the head fragment remains dorsal to the body. Dorsal malunion can lead to symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion. Canale found that 3 of the 4 patients with dorsal malunion improved following dorsal beak resection of the talar neck. Patients with varus malunion have decreased subtalar range of motion(especially eversion), walk with the foot internally rotated, and often complain of excessive weight bearing on the lateral border of the foot.

Level 4 evidence from Canale and Kelly found that varus malunion occurred most frequently in Hawkins type 2 fractures that had been treated in a closed manner.

Illustrations: A

REFERENCES:

1. Sanders R: Fractures and fracture-dislocations of the talus, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. Mosby 1999, pp 1465-1518

2. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978 Mar;60(2):143-56. PMID: 417084 (Link to Abstract)

Question Authors:

Michael Hughes MD, Ben Taylor MD,

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TAG

(OBQ04.126) A 30-year-old male sustains the injury shown in figure A and undergoes successful open reduction and internal fixation. Which of the following radiographic features is a good prognostic factor for this injury? Topic

Review Topic

FIGURES: A

1. Talar dome subchondral lucency
2. Talar dome subchondral sclerosis
3. Diffuse ostepenia
4. Associated medial malleolus fracture
5. Talar lateral process fracture

PREFERRED RESPONSE ▶

DISCUSSION: Figure A demonstrates a talar neck fracture. A subchondral talar lucency at approximately 6 weeks postoperatively indicates revascularization of the talus and is a good prognostic factor for this injury (aka Hawkins' Sign and is exhibited by the arrows in Illustration A).

The talar neck blood supply is tenuous and is susceptible to avascular necrosis. The reference by Hawkins classified talar neck fractures and correlated the incidence of avascular necrosis with the degree of displacement and severity of the fracture: Type I = Nondisplaced vertical fractures (AVN 10%). Type II = Displaced with subtalar dislocation/subluxation (AVN > 40%). Type III = Displaced with talar body dislocation (AVN >90%). Type IV = Displaced with talar head subluxation and body extrusion (AVN 100%).

The reference by Canale et al reviewed long term outcomes after ORIF of talar neck fractures, and they found that good or excellent results were seen in only 59%. Salvage procedures such as triple arthrodesis, tibiocalcaneal fusion, and dorsal beak resection of the talar neck all resulted in a high percentage of satisfactory results, but talectomy did not.

Illustrations: A

REFERENCES:

1. Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978 Mar;60(2):143-56 PMID:417084 (Link to Abstract)

2. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970 Jul;52(5):991-1002 PMID:5479485 (Link to Abstract)

Question Authors:

Ben Taylor MD, Derek Moore, Jan Szatkowski MD,

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TAG

(OBQ04.145) A 47-year-old male sustains the closed injury seen in Figures A and B after failing to land a motorcycle jump. A post-reduction radiograph, showing anatomical alignment, is seen in Figure C. What is the most appropriate treatment at this time? Topic

Review Topic

FIGURES: A

1. Definitive closed treatment
2. Addition of percutaneous pins
3. Open reduction and internal fixation
4. Tibiotalocalcaneal arthrodesis
5. Primary subtalar arthrodesis

PREFERRED RESPONSE ▶

DISCUSSION: The clinical presentation and imaging studies are consistent with Hawkins II talar neck fracture, which by definition is a displaced talar neck fracture with subtalar dislocation/subluxation. Despite achieving an anatomical reduction initially (shown in Figure C), there is no role for closed treatment of these unstable injuries, and the treatment of choice is open reduction and internal fixation.

The referenced article by Bibbo et al describes these injuries: 32% of subtalar joints are irreducible to closed means (half with soft tissue block, half with bony block to reduction), 88% have co-existing injuries of the ipsilateral foot, 89% have radiographic subtalar arthrosis at 5 years (62% symptomatic).

REFERENCES:

1. Bibbo C, Anderson RB, Davis WH: Injury characteristics and the clinical outcome of subtalar dislocations: A clinical and radiographic analysis of 25 cases: Foot and Ankle Int 2003; 24: 158-163 PMID:12627624 (Link to Abstract)

2. Kellam JF, Fischer TJ, et al (eds): OKU trauma 2. AAOS 2000, p 19-76

Question Authors:

Ben Taylor MD, Jan Szatkowski MD, John Badylak MD,

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TAG

(OBQ04.173) A 30-year-old male undergoes successful surgical fixation of the injury shown in Figures A and B. Which of the following is the most likely long-term complication even after anatomic reduction and stable fixation is achieved? Topic

Review Topic

FIGURES: A

1. Tibiotalar and/or subtalar arthritis
2. Loss of forefoot supination
3. Osteonecrosis
4. Nonunion
5. Infection

PREFERRED RESPONSE ▶

DISCUSSION: Figures A and B show a displaced talar neck fracture. It is important to counsel patients regarding these devastating injuries and their poor prognosis, as osteonecrosis, subtalar and tibiotalar joint degeneration, and talar collapse are not infrequent.

In a series by Lindvall et al, subtalar joint arthritis was reported as more common than osteonecrosis of the talus at 4 year follow-up after fixation. Osteonecrosis of the talus was the next most common complication following surgery.

The referenced article by Vallier et al reported on mid- to long-term follow-up of this patient population. Ten of the twenty-six patients had development of osteonecrosis of the talar body, but only half experienced collapse of the talar dome. All patients with a history of both an open fracture and osteonecrosis experienced collapse. Seventeen of twenty-six patients had posttraumatic arthritis of the tibiotalar joint, and nine of twenty-six had posttraumatic arthritis of the subtalar joint.

REFERENCES:

1. Kellam JF, et al (eds). OKU: Trauma 2. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2000, pp 57-73pp

2. Vallier HA, Nork SE, Benirschke SK, Sangeorzan BJ. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003 Sep;85-A(9):1716-24. PMID:12954830 (Link to Abstract)

3. Lindvall E, Haidukewych G, DiPasquale T, Herscovici D Jr, Sanders R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004 Oct;86-A(10):2229-34. PMID:15466732 (Link to Abstract)

Question Authors:

Ben Taylor MD, Patrick McCulloch MD,

Please Rate Educational Value!

2.0

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Evidence & References Show References

Level of Evidence 4 (Case Series)

Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978 Mar;60(2):143-56 PMID:417084 (Link to Abstract)
Canale ST, Kelly FB Jr. Fractures of the neck of the talus. Long-term evaluation of seventy-one cases. J Bone Joint Surg Am. 1978 Mar;60(2):143-56. PMID: 417084 (Link to Abstract)
Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970 Jul;52(5):991-1002 PMID:5479485 (Link to Abstract)
Huang PJ, Cheng YM. Delayed surgical treatment for neglected or mal-reduced talar fractures. Int Orthop. 2005 Oct;29(5):326-9. Epub 2005 Aug 11 PMID:16094539 (Link to Abstract)
Monroe MT, Manoli A 2nd. Osteotomy for malunion of a talar neck fracture: a case report. Foot Ankle Int. 1999 Mar;20(3):192-5. PubMed PMID: 10195299 PMID:10195299 (Link to Abstract)
Sanders DW, Busam M, Hattwick E, et al: Functional outcomes following displaced talar neck fractures. J Orthop Trauma 2004;18:265-270 PMID:15105747 (Link to Abstract)
Tezval M, Dumont C, Sturmer KM: Prognostic reliability of the Hawkins sign in fractures of the talus. J Orthop Trauma 2007;21:538-543 PMID:17805020 (Link to Abstract)

Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions, Personal Observations, and Biomechanic Studies)

Daniels TR, Smith JW, Ross TI. Varus malalignment of the talar neck. Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am. 1996 Oct;78(10):1559-67. PMID:8876585 (Link to Abstract)
Daniels TR, Smith JW, Ross TI: Varus malalignment of the talar neck: Its effect on the position of the foot and on subtalar motion. J Bone Joint Surg Am 1996;78:1559-1567 PMID:8876585 (Link to Abstract)
Herscovici D Jr, Anglen JO, Archdeacon M, et al: Avoiding complications in the treatment of pronation-external rotation ankle fractures, syndesmotic injuries, and talar neck fractures. J Bone Joint Surg Am 2008;90:898-908 PMID:18381329 (Link to Abstract)

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Sanders R: Fractures and fracture-dislocations of the talus, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. Mosby 1999, pp 1465-1518

Undefined

Richardson EG (ed): Orthopaedic Knowledge Update: Foot and Ankle 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 35-46.
Bibbo C, Anderson RB, Davis WH: Injury characteristics and the clinical outcome of subtalar dislocations: A clinical and radiographic analysis of 25 cases: Foot and Ankle Int 2003; 24: 158-163 PMID:12627624 (Link to Abstract)
Fortin PT, Balazsy JE. Talus fractures: evaluation and treatment. J Am Acad Orthop Surg. 2001 Mar-Apr;9(2):114-27. PMID:11281635 (Link to Abstract)
Heckman JD: Fractures of the talus, in Bucholz RW, Heckman JD (eds): Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 2091-2132
Kellam JF, et al (eds). OKU: Trauma 2. Rosemont, IL. American Academy of Orthopaedic Surgeons, 2000, pp 57-73pp
Kellam JF, Fischer TJ, et al (eds): OKU trauma 2. AAOS 2000, p 19-76
Lindvall E, Haidukewych G, DiPasquale T, Herscovici D Jr, Sanders R. Open reduction and stable fixation of isolated, displaced talar neck and body fractures. J Bone Joint Surg Am. 2004 Oct;86-A(10):2229-34. PMID:15466732 (Link to Abstract)
Sarrafian SK: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional Philadelphia, PA, JB Lippincott, 1983.
Vallier HA, Nork SE, Benirschke SK, Sangeorzan BJ. Surgical treatment of talar body fractures. J Bone Joint Surg Am. 2003 Sep;85-A(9):1716-24. PMID:12954830 (Link to Abstract)

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Talar Neck Fractures

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