Case Talar neck fractures are uncommon injuries associated with a high risk of avascular necrosis (AVN), particularly when accompanied by open fracture-dislocation and associated ankle fractures. Hawkins type IV injuries represent the most severe form and are associated with reported AVN rates of up to 100%. We report a rare case of a Hawkins and Canale type IV open talar neck fracture-dislocation with concomitant bimalleolar ankle fracture and lateral talar process fracture that achieved a favorable long-term outcome. A 66-year-old man sustained a Hawkins and Canale type IV open talar neck fracture-dislocation with a bimalleolar ankle fracture and a lateral talar process fracture after a fall from a ladder. The talus was completely dislocated from the tibiotalar, subtalar, and talonavicular joints. Emergent irrigation, debridement, and external fixation were performed, followed by internal fixation 8 days after injury. Magnetic resonance imaging(MRI) at 1 year showed no talar necrosis, and radiographs at 7 years demonstrated no collapse. Conclusion Even in high-risk open talar fracture-dislocations, favorable long-term outcomes may be achieved through timely reduction and staged surgical management with an emphasis on soft-tissue preservation.
Fukuda et al. (Mon,) studied this question.