Overview
what it is and why it mattersA talus fracture is a break in the small but critical bone that sits at the top of your foot, between your shin bones and your heel. The talus is the bone that transfers your entire body weight from your leg into your foot every step. It also has a famously fragile blood supply — most of its surface is covered in cartilage, leaving very little room for blood vessels to enter. So when it breaks badly, the fragments can lose their blood supply and die — a problem called avascular necrosis (AVN). The risk goes up with displacement: a clean undisplaced crack carries almost no AVN risk, but a fully dislocated talus has up to a 90% chance of the bone dying.
Diagnosis
exam first, imaging secondThree X-ray views including a special angled view for talar neck fractures. A CT scan is mandatory before surgery to map the fracture in 3D. An MRI is used at follow-up to check whether the bone is dying. There's actually a useful early sign on follow-up X-rays — the Hawkins sign — a thin dark line under the cartilage of the talus that means blood is reaching the bone again, which is a very good sign.
Treatment Path
how care progresses at OSINon-weight-bearing cast
Only the cleanest, undisplaced talar neck fractures (Hawkins type I) are managed without surgery — a non-weight-bearing cast through the bone-healing phase, with close follow-up X-rays to catch any shifting or signs of bone death.
Surgical Options at OSI
if non-operative care isn't enoughDisplaced talar neck fractures need urgent surgery to put the bone back in exactly the right position — every additional day of malalignment raises the AVN risk. A dislocated talar body is a true surgical emergency, both to relieve skin pressure and to give the bone its best shot at keeping its blood supply.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: