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Pedal to the Metal
A 32-year old female presents to the emergency department with right ankle pain after a high speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the dorsal foot, and pain with ankle dorsiflexion and plantarflexion.
Pedal to the Metal
Author: Justine Ko, MD
Peer-reviewer: Terese Whipple, MD
Final editor: Alex Tomesch, MD
A 32-year old female presents to the emergency department with right ankle pain after a high speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the dorsal foot, and pain with ankle dorsiflexion and plantarflexion.
Image 1. Case courtesy of Dr Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 18235
What is your management in the ED?
Management depends on the type of talar neck fracture. The most common classification system for talar neck fractures is the Hawkins-Canale classification:
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Type I fractures: nondisplaced fractures that usually only require splinting and non-weight bearing status.
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Type II-IV fractures are displaced fractures with an associated dislocation that requires urgent reduction in the emergency department
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Type II fractures: talocalcaneal dislocation
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Type III fractures (Image 2): talocalcaneal and talotibial dislocations
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Type IV: all talar articulations disrupted.[3,4]
- Pearl: Most talar injuries are usually caused by forced hyperdorsiflexion of the ankle. They are often associated with other injuries in the patients and frequently present as an open fracture.[1] A detailed secondary survey and skin exam should be performed on all patients.
Image 2: Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 84976
References
[1] Shamrock AG, Byerly DW. Talar Neck Fractures. In: StatPearls. StatPearls Publishing; 2021. Accessed June 19, 2021. http://www.ncbi.nlm.nih.gov/books/NBK542315/1.
[2] Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB. Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification. Radiographics. 2015;35(3):765-779. doi:10.1148/rg.2015140156
[3] Dale JD, Ha AS, Chew FS. Update on Talar Fracture Patterns: A Large Level I Trauma Center Study. American Journal of Roentgenology. 2013;201(5):1087-1092. doi:10.2214/AJR.12.9918
[4] Alton T, Patton DJ, Gee AO. Classifications in Brief: The Hawkins Classification for Talus Fractures. Clin Orthop Relat Res. 2015;473(9):3046-3049. doi:10.1007/s11999-015-4136-x
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