Seventy-one fractures through the neck of the talus were clinically
evaluated and classified on the basis of roentgenographic appearance. The
follow-up interval averaged 12.7 years. Good or excellent results were
achieved in 59 per cent of the fractures. Accurate anatomical reduction of
displaced fractures, if necessary by open reduction and internal fixation,
is recommended. Avascular necrosis of the talar body occurred in 52 per
cent of the fractures (in two of thirteen non-displaced fractures, in half
of the fractures with subluxation or dislocation of the subtalar joint, and
in sixteen of nineteen fractures with complete dislocation of the body of
the talus). Many patients with avascular necrosis treated conservatively
had satisfactory results. The complications of avascular necrosis,
malunion, subtalar arthritis, and infection required twenty-five secondary
procedures. Triple arthrodesis, tibiocalcaneal fusion, and dorsal beak
resection of the talar neck all resulted in a high percentage of
satisfactory results, but talectomy did not.