Talar Neck Fracture Fixation

Indications

• Displaced talar neck fractures, Hawkins II to IV
• Urgent reduction of dislocated fragments to protect skin
• Undisplaced fractures confirmed on CT can be treated in a cast
• Open fractures need urgent debridement and stabilisation

Position

• Supine, bump under the hip
• Image intensifier positioned for lateral, AP and Canale views
• Thigh tourniquet

Operative Steps

1. Dual anteromedial and anterolateral approaches show comminution and prevent varus malreduction
2. Protect the deltoid branch of the posterior tibial artery
3. Reduce the neck, checking length on both sides
4. Two screws, posterior to anterior screws are biomechanically stronger
5. Lateral mini fragment plate across comminution to hold length
6. Check with Canale view
7. Medial malleolar osteotomy for body extension or a dislocated body
8. Avoid stripping the dorsal neck and the sinus tarsi to preserve blood supply
9. Temporary external fixation if soft tissues are poor

Postoperative Care

• Non weight bearing for 8 to 12 weeks
• Hawkins sign at 6 to 8 weeks, subchondral lucency, means the dome is revascularising
• Early ankle and subtalar motion once the wound has healed
• Radiographs at 2, 6 and 12 weeks

Complications

• Avascular necrosis
• Varus malunion
• Subtalar and ankle arthritis
• Wound breakdown and infection
• Nonunion is less common than AVN

Related Pages

• Talar Neck Fractures
• Talus Fractures

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.