Hawkins et al developed a classification for fractures involving the neck of the talus. These injuries usually occur following events with high kinetic energy (falls from height, airplane crashes, high speed vehicular, etc).
Talar Injuries
Group
vertical neck fracture, undisplaced
1
displaced fracture with subtalar dislocation
2
displaced fracture with ankle and subtalar dislocation
3
displaced fracture with ankle, subtalar and navicular dislocation
4
Group
Other Injuries
Arteries Affected
Avascular Necrosis
1
none
dorsal neck
5% in talar body
2
dorsal neck, tarsal sling
34%
3
open fracture common
dorsal neck, tarsal sling, deltoid
78%
4
open fracture common
dorsal neck, tarsal sling, deltoid
78%, may involve head, neck, body
Closed reduction of Group 3 or 4 fractures are rarely successful.
Reduction of a Group 2 fracture may be an emergency if the distal neck fragment stretches the skin over the sinus tarsi.
Avascular necrosis usually can be seen on X-rays 6-8 weeks after the injury with sclerosis of the talar body relative to surrounding bone. However, it may appear earlier or later (6 months or more).
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