Talar neck fractures.

Talar neck fractures represent a serious injury, and a review of the literature reveals the controversies surrounding the treatment options. In spite of the differences, there are many aspects of management where little disagreement exists. Anatomic reduction is the goal in situations where a primary salvage procedure is not performed. If closed treatment is chosen, careful follow-up is necessary to prevent unrecognized displacement as swelling subsides in the cast. Weight-bearing should be delayed until radiographic signs of fracture healing are obvious. There is a growing tendency toward open reduction and internal stabilization of talar neck fractures. Results suggest improved maintenance of reduction, decreased time to union, and a better end result. Prior to attempting any type of salvage procedure, careful assessment of both the tibiotalar and subtalar complex is necessary. The incidence of poor results following a talar neck fracture is disappointingly high. Additional studies of the pathoanatomy and biomechanics may improve our understanding. Controlled prospective clinical series will help clarify the advantages of specific treatment approaches and lead to better clinical results.