Fractures of the neck of the talus.

Talar neck fractures should be managed with meticulous attention to detail, and anatomical reduction is mandatory. Most type I fractures can be treated closed, unless there is loss of reduction, but type II, III, and IV, especially if displaced, usually require open reduction and internal fixation. Closed reduction may be attempted, but if the reduction is lost, or satisfactory reduction cannot be obtained, open reduction should be performed. Two incisions may be necessary to confirm accurate anatomical reduction. Poor results occur because of avascular necrosis, malunion, subtalar arthritis, and infection. Attention to detail can decrease the incidence of the latter three of these complications; the development of avascular necrosis does not seem to be related to the type of treatment. Though the most serious complication, avascular necrosis, may not require surgical intervention, many of the authors' patients have done well with conservative treatment.