Diagnosis and treatment of talar dislocation fractures illustrated by 3 case reports and review of literature

INTRODUCTION: Talar fractures are a rare type of fractures (less than 1%). They are difficult to treat and outcome is often complicated by arthritis and avascular necrosis. In this article three cases are presented with different types of dislocated talar neck fractures. Anatomy of the talus, treatment, outcome and follow up of these fractures are discussed. Further, review of literature and guidelines for treatment and follow up for dislocated talar neck fractures are discussed. DISCUSSION: The risk of developing arthritis or avascular necrosis of the talus after dislocated talar neck fractures depends on the initial trauma with vascular compromise due to dislocation of the talus. The modified Hawkins classification gives an insight in the risk of developing avascular necrosis. During follow up the Hawkins sign can be an indication of a vital talus. To diagnose avascular necrosis MRI is the only suitable diagnostic tool. CONCLUSION: Reduction of a dislocated talar fracture is a medical emergency in an effort to reduce the vascular compromise of the talus. Definitive fixation can be delayed but should be performed by an experienced surgeon to achieve an optimal reconstruction of the talar surface. Long-term follow up is important to evaluate signs of arthritis and avascular necrosis.