Talus fractures of the ankle usually occur in young, active patients. In most cases, patients will present immediately after an injury with severe pain, swelling, and possible deformity of the ankle after a high-energy injury (eg, car accident, motorcycle accident, fall from height).

Talar neck (mid-portion) fractures are the most common type of talus fracture, accounting for 50% of cases. Talar neck fractures can be categorized from I-IV using the Hawkins classification: Hawkins I is nondisplaced, and Hawkins II-IV refer to talus fracture with concomitant subtalar (II), tibiotalar (III), and talonavicular dislocation (IV), respectively. The blood supply to the talus is poor, so avascular necrosis is common for talar neck fractures.

More important than knowing the Hawkins classification is to recognize these fractures as very serious injuries. Orthopedics should be consulted immediately and a CT scan obtained. It is very common to have additional ipsilateral lower extremity fractures.

Other fractures of the talus, in order of decreasing prevalence, include talar body (located beneath the tibia), lateral process, and head (located further down the foot). These other fractures may result from a lower energy mechanism of injury or be discovered with advanced imaging when a patient has been managed for an ankle sprain but is slow to heal. Because these fractures can also occur in high-energy trauma, they are discussed together. Lateral process fractures can occur from athletic injuries, classically from snowboarding, as the ankle is dorsiflexed and externally rotated during a hard landing.

Related topics: ankle injury, ankle fracture, foot fracture