upload_bybbi3ian3hfu737jk4buedz4m.pdf

3

J Gandhara Med Dent Sci

ORIGINAL ARTICLE

October - December 2026

How to cite this article

:

OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION OF ISOLATED TALUS NECK

FRACTURES VERSUS FIXATION OF TALUS NECK FRACTURES WITH CONCOMITANT

IPSILATERAL FOOT AND ANKLE FRACTURES

Faaiz Ali Shah

1

Aimal Sattar

2

Zia Ullah Jan

3

,

Shah FA, Sattar A, Jan ZU. Outcome

of Open Reduction and Internal

Fixation of Isolated Talus Neck

Fractures Versus Fixation of Talus

Neck Fractures with Concomitant

Ipsilateral Foot and Ankle Fractures. J

Gandhara Med Dent Sci. 2026;13(4):3-8.

Date of Submission:

27-07-2026

Date Revised:

07-09-2026

Date Acceptance:

07-09-2026

Correspondence

2

Aimal Sattar, Assistant Professor

+92-300-5924948

draimalsattar@gmail.com

ABSTRACT

OBJECTIVES

This

study

aimed

to

compare

the

radiological

and

functional

outcomes

of

open

reduction

and

internal

ﬁxation

of

isolated

Talus

neck

fractures

with

Talus neck ipsilateral foot and ankle fractures.

METHODOLOGY

This retrospective study was conducted in the Orthopaedics Division, Lady

Reading

Hospital,

Peshawar.

The

medical

records

of

Talus

neck

fractures

fulﬁlling

the

inclusion criteria

and

operated

on in

the

last

ﬁve

years

were

reviewed. Patients were divided into group A (isolated Talus neck fractures)

and group B (Talus neck fracture with concomitant ipsilateral foot and ankle

fractures).

Postoperative

radiological

fracture

union,

osteoarthritis,

avascular

necrosis

(AVN)

and

functional

outcome

using

the

American

Orthopaedic Foot and Ankle Society (AOFAS) were assessed

and compared

in both groups.

RESULTS

34 patients, with 18 (52.94%) patients in group A and 16 (47.05%) in group

B.

The

mean

AOFAS

score

at

one

year

was

95.34±3.3

in

group

A

and

74.11±2.2 in group B (P=0.001). Non-union was noted in 1(6.25%) patient in

group B and none in group A. AVN Talus

was documented in 02(11.11%)

patients

in

group

A

and

07(43.75%)

in

group

B(P=0.02).

Postoperative

osteoarthritis was noted in 3(16.66%) patients in group A and 5(31.25%) in

group B. Multivariate regression analysis revealed that smoking, concomitant

ipsilateral

foot

and

ankle

fractures,

fracture

classiﬁcation

and

quality

of

postoperative

fracture

reduction

were

signiﬁcant

predictors

of

increased

postoperative AVN of the Talus.

CONCLUSION

Open

reduction

and

internal

ﬁxation

of

isolated

Talus

neck

fractures

have

signiﬁcantly

better

radiological

and

functional

outcomes

than

ﬁxation

of

Talus fractures with concomitant ipsilateral foot and ankle fractures.

KEYWORDS:

Avascular Necrosis, Hawkins Classiﬁcation, Open Reduction

and Internal Fixation, Outcome, Talus Neck

INTRODUCTION

Fracture

of

the

talus

is

a

relatively

uncommon

but

disabling fracture with an incidence of 0.1 to 2.5 % of

all fractures, and 3% to 5% of foot and ankle fractures.

More than 50% of the talus fractures involve the neck

of the Talus.

1

Anderson termed Talar neck fractures as

"Aviator

Astragalus"

in

1919

after

observing

an

increased

frequency

of

these

fractures

in

wartime

fighter pilots during plane crashes resulting in forceful

dorsiflexion

of

the

ankle

and

tibiotalar

axial

compression.

2

Talus

fractures

are

usually

encountered

in younger persons due to high-energy trauma like road

trafﬁc accidents, falls from signiﬁcant height and sports

injuries.

3

Because

of

its

soft

tissue

envelope

that

is

potentially

unforgiving,

its

complex

anatomy,

critical

and

unique

blood

supply

and

abundant

articular

cartilage

coverage,

the

talus

is

very

vulnerable

to

avascular necrosis(AVN), particularly after a displaced

fracture of the neck of the talus.

1

The risk of AVN in

fracture

of

the

talus

neck

is

subtalar

joint

dislocation,

as

AVN

is

reported

in

25%

to

50%

of

patients with fracture of the talus neck associated with

subtalar joint dislocation.

4

Other complications include

infection,

non-union,

malunion

and

post-traumatic

osteoarthritis, all leading to adverse functional outcome

and

compromised

quality

of

life.

5

Undisplaced

Talus

neck

fractures are treated non-operatively. In contrast,

displaced fractures are treated with open reduction and

internal

ﬁxation.

6

Depending

upon

fracture

geometry

and

overlying

skin

conditions,

a

variety

of

ﬁxation

techniques have been employed for treating Talus neck

fractures, including K

wires,

external

ﬁxators, screws,

mini

fragment

and

ﬁxed

angle

plates.

7

Anatomical

reduction,

stable

fracture

ﬁxation

and

early

mobilization,

however,

should

be

the

aim

of

fracture

fixation.

1

Fracture of the Talus may have concomitant

fractures of the foot and ankle, including fracture of the

3

Specialist Registrar, Department of

Orthopaedic, Lady Reading Hospital,

Peshawar

1

Associate Professor, Department of

Orthopaedic, Lady Reading Hospital,

Peshawar

Department of

Orthopaedic, Lady

Reading Hospital, Peshawar

http://doi.org/10.37762/jgmds.13-4.977

4

J Gandhara Med Dent Sci

October - December 2026

medial

malleolus

(11%),

fracture

of

the

lateral

malleolus(6%), bi-malleolar fractures (6%) and fracture

of the calcaneus (6%).

8

Studies have shown that Talar

neck

fractures

with

concomitant

foot

and

ankle

fractures

cause

increased

morbidity,

more

frequently

require secondary surgery and pose a signiﬁcant risk of

AVN

than

isolated

Talar

neck

fractures.

9,10

Displaced

concomitant fractures of the foot and ankle may require

simultaneous

or

staged

open

reduction

and

internal

fixation,

but

the

optimum

treatment,

however,

is

still

controversial.

10

Furthermore,

limited

literature

is

available

regarding

comparison

of

functional

and

radiological

outcome

of

isolated

Talus

neck

fracture

with

concomitant

ipsilateral

foot

and

ankle

fractures.

The

objective

of

our

study

was

to

compare

the

radiological and functional outcomes of open reduction

and

internal

ﬁxation

of

isolated

Talus

neck

fractures

with

Talus

neck

fractures

with

concomitant ipsilateral

foot and ankle fractures. To the best of our knowledge,

this will be the ﬁrst study in Pakistan. The results of our

study

will

help

in

better

understanding

of

Talus

neck

and ipsilateral foot and ankle fractures, particularly in

terms of prognosis and counselling of the patient. This

would

help

in

the

formulation

of

institutional

and

national

evidence-based

management

protocols

for

Talus

neck

fractures

with

concomitant

ipsilateral

foot

and ankle fractures.

METHODOLOGY

This

retrospective

study

was

conducted

in

the

Orthopaedic

Department,

Lady

Reading

Hospital

Peshawar. Ethical approval of the study was granted by

the Institutional Review Board, Lady Reading Hospital

Peshawar

(No.310/LRH/MTI,

dated:19/05/2026).

Medical

records of

all

patients

who

were

operated on

for

Talus

neck

fractures

during

the

time

period

extending

from

Jul

2020

to

Jul

2025

were

extracted

from

the

electronic

Health

Management

Information

System (eHMIS) of our hospital.

All adult patients of

both genders and all ages who were received within a

week

after

sustaining

closed

Talus

neck

fractures

(Hawkins type II, III, IV) with or without concomitant

foot

and

ankle

fractures

and

operated

on

with

open

reduction

and

internal

screw

ﬁxation

for

Talus

neck

fractures in our hospital were included in this study.

11

All the included patients had complete radiological and

clinical records, and a follow-up duration of more than

one

year.

All

open

Talus

fractures,

re-surgery

cases,

pathological

fractures,

bilateral

fractures

and

those

associated with neuropathic foot, lower limb and upper

limb long bone fractures were excluded. All the patients

had complete history and radiological investigations (x-

ray

ankle

AP,

lateral

view,

Mortise

view

and

3D

CT

scan).

All

the

patients

were

operated

on

by

the

same

surgical

team

with

identical

surgical

protocol.

All

the

patients

were

operated

on

a

radiolucent

table

under

general

or

spinal

anaesthesia

and

tourniquet

control,

with

the

patient

in

supine

position

and

C-arm

assistance.

Anterolateral

approach

for

open

reduction

and

internal

ﬁxation

of

Talus

neck

fractures

was

adopted

in

all

cases.

In

this

approach,

a

10

cm

skin

incision

starts about

3

cm

proximal

to

the

ankle

joint

along the lateral

margin of Extensor Hallucis

Longus.

The

fracture

site

was

exposed,

reduced,

and

provisionally

held

with

one

or

two

K

wires.

After

confirming fracture and joint reduction under the image

intensifier,

two

parallel

proper-size

4

mm

cancellous

screws were passed from the head of the talus towards

the

neck

and

body of

the

talus,

and

compression

was

applied. Fracture reduction and screws placement were

again

checked

with

the

image

intensiﬁer.

(ﬁg

I)

The

wound was closed in layers, and a below-knee fracture

splint was applied. All patients with talus neck fractures

with

concomitant

ipsilateral

foot

and

ankle

fractures

were

treated

simultaneously

for

their

associated

fractures.

Depending

upon

the

fracture

type

and

displacement, the associated fractures were treated with

either

K

wires

or

screws.

(ﬁg

II)

Post

operatively

the

quality

of

fracture

reduction

was

radiographically

assessed

using

Lindvall

criteria

and

labelled

as

Anatomical Reduction (no step in the neck or body and

no angulation), Nearly Anatomical Reduction (step of 1

to 3mm or varus angulation of less than 5 degrees) and

Poor reduction (articular mismatch or a step or gap of

more

than

3

mm

or

angulation

of

neck

more

than

5

degrees).

12

Figure

1: Radiographs

Showing

Isolated

Talus

Neck

Fracture (Hawkins Type Ii) Fixation

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck

5

J Gandhara Med Dent Sci

October - December 2026

Figure

2:Radiographs

Showing

Simultaneous

Fixation of

TalusNeck Fracture and Concomitant Medial Malleolus Fracture

All

the

patients

followed

a

supervised

rehabilitation

protocol with regular follow-up in OPD. Partial weight

bearing

was

allowed

at

6

to

8

weeks

and

full

weight

bearing

at

10

to

12

weeks,

depending

upon

clinical

symptoms

of

absence

of

pain

and

radiological

appearance

of

callus

formation

and

obliteration

of

fracture

lines.

The

radiological

outcome

at

one-year

follow-up

included

fracture

union,

non-union,

mal-

union, osteoarthritis and AVN. The functional outcome

was assessed using the American Orthopaedic Foot and

Ankle

Society

(AOFAS)

score

and

interpreted

as

excellent outcome (90 to 100 score), good (70 to 89),

fair

(50

to

69)

and

poor

outcome

(<50).

13

For

comparative

analysis,

the

records

of

all

patients

with

fracture of the neck of the talus were divided into two

groups.

Group

A

had

ORIF

of

isolated

Talus

neck

fractures,

while

group

B

had

ORIF

of

talus

neck

fractures with treatment of concomitant ipsilateral foot

and ankle fractures. SPSS version 27 was used for data

analysis.

RESULTS

The

data

of

34

Talus

neck

fractures,

including

18(52.94%)

isolated

Talus

neck

fractures

(Group

A)

and

16(47.05%)

Talus

neck

fractures

with

ipsilateral

foot and ankle fractures (Group B), were available for

analysis.

Table 1: Comparison of Baseline Demographic and Clinical

Variables of Both Groups.

n=18(52.94%)

n=16 (47.05 %)

Variables

Isolated Talus

neck fractures

(Group A)

Talus neck Ipsilate

ral foot and ankle

fractures (Group B)

p-value

Age(Years)

32.41±3.12

31.33±2.11

0.10

Gender:

.Male

.Female

16(88.88%)

02(11.11%)

15(93.75%)

01(6.25%)

0.09

Aetiology of

fracture:

.Road traffic

accidents

.Fall from height

15(83.33%)

03(16.66%)

14(87.5%)

02(12.5%)

0.22

Side of fracture:

.Right

.Left

14(77.77%)

04(22.22%)

13(81.25%)

03(18.75%)

0.31

Smoking status:

.Nonsmoker

.Smoker

11(61.11%)

07(38.88%)

12(75%)

04(25%)

0.08

Diabetes Mellitus:

.No

.Yes

17(94.44%)

01(5.55%)

15(93.75%)

01(6.25%)

0.30

Hawkins

classification:

.Type II

.Type III

.Type IV

12(66.66%)

04(22.22%)

02(11.11%)

10(62.5%)

03(18.75%)

0.12

Postoperative

radiographic

fracture

reduction

(Lindvall

criteria):

.Anatomical

Reduction

.Nearly

Anatomical

Reduction

.Poor reduction

15(83.33%)

02(11.11%)

01(5.55%)

13(81.25%)

01(6.25%)

02(12.5%)

0.06

Average union

time(months)

6.41±2.2

7.33±1.7

0.81

Average follow-

up(months)

14.4±2.2

15.1±1.3

0.11

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck

6

J Gandhara Med Dent Sci

October - December 2026

DISCUSSION

In our study, all the Talus fractures united in group A,

while

in

group

B,

2(12.5%)

patients

did

not

unite.

Avascular necrosis was noted in 02(11.11%) patients in

group

A

and

07(43.75%)

in

group

B(

P

<0.05).

Postoperative osteoarthritis was recorded in 3(16.66%)

patients

in

group

A

and

5(31.25%)

in

group

B.

The

functional outcome was signiﬁcantly better(

P

<0.05) in

group A (mean AOFAS score 95.34±3.3) than in group

B

(mean

AOFAS

score

74.11±2).

After

an

extensive

literature review, we observed that most of the literature

on talus neck fractures with concomitant ipsilateral foot

and

ankle

fractures

consists

of

case

reports

and

case

series,

and

good

quality

prospective

studies

are

lacking.

14,15,16,17

Nonetheless,

four

main

reasons

can

explain this adverse outcome of ﬁxation of Talus neck

fractures

with

concomitant

ipsilateral

foot

and

ankle

fractures

in

our

study.

First,

patients

with

talus

neck

fractures

sustained

concomitant

ipsilateral

foot

and

ankle fractures due to very high-energy trauma, which

causes

severe

initial

fracture

displacement,

involves

multiple

articular

surfaces

and

signiﬁcantly

damages

the soft tissue envelope, which further compromises the

blood

supply

of

the

talus

and

healing

potential.

9

Although

anatomical

reduction

of

the

Talus

fracture

was critical in both groups, concomitant ipsilateral foot

and ankle fractures worsened the outcome independent

of

ﬁxation

quality

of

the

Talus.

Second,

the

postoperative rehabilitation and mobilization of the foot

with

concomitant

fractures

was

relatively

delayed,

which

caused

impaired

circulation

to

the

extremity,

Table 2:

Univariate

and

Multivariate

Logistic

Regression

for

Predicting AVN in Our Study.

Variable

Univariate Regression

Analysis

Multivariate Regression

Analysis

Odds

Ratio

(OR)

95% Conﬁ

dence Inter

val (CI)

p-va

Odds

Ratio

(OR)

95% Conﬁ

dence Inter

val (CI)

p-value

Age

1.20

0.41-3.51

0.73

--

Gender

0.91

0.52-1.59

0.31

--

Fracture side 0.75

0.33-1.70

0.94

--

Aetiology of

fracture

1.22

0.83-1.79

0.11

--

Smoking

1.61

1.04-2.49

0.03

1.78

1.24-2.56

0.002

Diabetes

0.33

0.09-1.21

0.64

--

Concomitant

Ipsilateral Fo

ot and Ankle

Fractures

2.01

1.18-3.42

0.01

2.11

1.35-3.30

0.001

Fracture

classiﬁcation

2.03

1.30-3.17

0.00

2

2.01

1.07-3.78

0.03

Post-Operati

ve fracture

reduction

1.73

1.08-2.77

0.02

1.81

1.15-2.85

0.01

Follow-up

period

1.12

0.60-2.11

0.12

--

lue

resulting in inferior functional outcome in group B than

in group A.

18

Third, studies have shown that there is

significantly

increased

activity

of

Osteoclasts

and

all

other

markers

of

inﬂammation

in

multiple

fractures

compared to isolated Talus neck fractures, which may

contribute

to

chronic

inﬂammation

and

immune

modulation,

resulting

in

accelerated

pathogenesis

of

AVN

in

Talus

neck

fractures.

19,20

Fourth,

patients

in

group B had osteoarthritis and AVN and the associated

pain and discomfort signiﬁcantly contributed to lower

functional outcome in this group. Similar to our study,

Srinath

et al

9

compared the results of 63(55%) isolated

Talus neck fractures with 52(45%) Talus neck fractures

with

concomitant

ipsilateral

foot

and

ankle

fractures.

Both

groups

had

identical

baseline

demographic

characteristics.

The

rate

of

AVN

was

30%(n=19)

in

isolated Talus neck

fractures and 46%(n=24) in Talus

fractures

with

concomitant

fractures

of

the

foot

and

ankle.

After

adjusting

for

confounders,

these

authors

concluded that the risk of AVN was higher in isolated

Talus neck fractures than in concomitant foot and ankle

fractures.

The

increased

frequency

of

AVN

was

significantly

associated

with

complex

fracture

type,

compromised

skin

envelope,

surgical

approach

and

fracture

reduction

quality.

In

our

study,

smoking,

concomitant ipsilateral foot and ankle fractures, fracture

classification

and

quality

of

fracture

reduction

were

significant

predictors

of

increased

postoperative

AVN

of

the

Talus.

Fracture

classiﬁcation(Hawkins)

reflects

injury severity and disruption of anatomical structures.

Our results showed a higher rate of AVN in Hawkins

type

III

than

type

II.

The

utility

of

the

Hawkins

classification

is

further

enhanced.

Furthermore,

accurate

fracture

reduction

tends

to

maximize

the

restoration

of

blood

circulation

around

the

talus.

This

implies

that

surgical

technique

should

be

meticulous

and

fracture

reduction

should

be

anatomical

to

avoid

AVN in both groups. Smoking causes disturbances in

the

microcirculation,

thrombosis

and

vasospasm,

resulting

in

reduced

blood

supply

and

ultimately

increasing

the

risk

of

AVN.

21

All

patients

with

talus

neck

fractures

should

be

strictly

advised

to

quit

smoking

in

the

perioperative

period

to

decrease

the

chances of postoperative AVN. Zhang et al

treated 207

Talus

fractures

(including

ipsilateral

concomitant

foot

and ankle fractures in 87 patients) and formulated and

validated

a

machine

learning

prediction

model

for

postoperative

AVN.

18

These

authors

identiﬁed

six

independent

risk

factors,

including

smoking,

BMI,

classification

of

Talus

fractures,

fracture

type,

associated

ipsilateral

foot

and

ankle

fractures

and

quality of postoperative fracture reduction for AVN of

the talus. Sautet and colleagues reviewed the records of

58 Talus

neck

fractures,

including

13 Hawkins

type

I

fractures, 30 type II and 15 type III fractures, with 64 %

isolated

Talus

neck

fractures.

22

These

authors

noted

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck

AVN

in

7%,

subtalar

osteoarthritis

in

45%

and

7

J Gandhara Med Dent Sci

October - December 2026

tibiotalar

in

19%.

Mean

AOFAS

was

74,

with

20%

having an excellent outcome,30% good,28% acceptable

and 22% poor outcome. This study reported that poor

fracture

reduction,

subtalar

osteoarthritis,

AVN

and

smoking were associated with poor functional outcome.

Alley

reported that 99(16.2%) patients out of a total of

610 in their study had medial malleolus fractures, with

an

overall

frequency

of

AVN

of

42.1%.

23

Advanced

age,

smoking,

dual

surgical

approach,

open

fractures,

concomitant

medial

malleolar

fractures,

and

Hawkins

type

IIA,

IIB

fractures

were

associated

with

an

increased risk of AVN (

P

<0.05) in this study.

Contrary

to our results, Roddy

et al

treated 128 Talus fractures

and

noted

that,

at

10.4

years

of

follow-up,

the

mean

Foot and Ankle Ability Measure(FAAM) score was 83,

post-traumatic

arthritis

was

47%,

and

the

re-surgery

rate

was

30%.

24

These

authors

reported

that

age,

location

of

fracture

and

ipsilateral

foot

and

ankle

fractures

were

not

associated

with

poor

outcomes;

rather,

increased

BMI,

higher

Injury

Severity

Score(ISS) and salvage procedure were associated with

poor

outcomes.

Similarly,

Daryoush

reported

that

sustentaculum

fractures

were

present

in

40.7%

of

Hawkins

II

(973.7%)

and

post-traumatic

subtalar

osteoarthritis was documented in 23.1%.

17

The rate of

subtalar osteoarthritis did not exceed in this combined

injury

at

24

months

when

compared

to

isolated

Talus

fracture.

We

ﬁxed

Talus

neck

fractures

with

4

mm

cannulated

screws,

as

there

are

no

superior

results

of

plate

ﬁxation

in

Talus

neck

fractures.

25

Moreover,

screw

ﬁxation

has

the

added

advantage

of

preserving

blood

supply

of

the

talus.

1

Lee

and

Ryu

treated

31

Talus

neck

fractures

(Hawkins

type

III)

and

achieved

union in all cases at 4.9

months.

26

The

AOFAS

score

and Foot Function Index (FFI) score were 80.18(range

36 to 90) and 31.43(range 10 to 68), respectively. AVN

was noted in 15(55%) patients, ankle arthritis in 6(22%)

patients and infection in 4(15%) patients. These authors

used

4

mm

cannulated

screws,

headless

screws

and

locking

compression

mini

plates

for

ﬁxation.

These

authors concluded that the technique of ﬁxation had no

signiﬁcant

association

with

functional

outcome

or

development

of

osteoarthritis(

p

>0.05).

We

used

the

anterolateral

approach

for

ﬁxing

all

Talus

neck

fractures in both groups. The literature supports the use

of

this

approach

for

ORIF

of

Talus

neck

fractures.

Parmeshwar treated 30 Talus neck fractures using three

approaches (anteromedial, anterolateral and combined)

and noted AFOFAS scores of 76.34, 77.16 and 78.34,

respectively,

at

18

months

of

follow-up.

27

These

authors

reported

no

signiﬁcant

association

of

surgical

approach with functional outcome.

LIMITATIONS

The

design

of

our

study

was

retrospective.

Although

our

multivariate

analysis

is

valuable

in

providing

exploratory

insight

into

postoperative

Avascular

Necrosis

of

the

Talus,

due

to

the

small

sample

size

(

n

=34)

and

low

total

AVN

events

(

n

=09),

the

Events

Per

Variable(EPV)

ratio

of

our

Multivariate

Logistic

Regression

is

low.

Therefore,

our

results

should

be

cautiously

interpreted,

and

further

validation

of

these

risk predictors with large sample size studies is needed.

Furthermore,

we

could

not determine

the

BMI

of

our

patients

or

the

association

of

BMI

with

ﬁxation

outcome. We therefore recommend further prospective

studies to verify our results.

CONCLUSIONS

Open reduction and internal

ﬁxation of isolated Talus

neck fractures have signiﬁcantly better radiological and

functional

outcomes

than

ﬁxation

of

Talus

fractures

with

concomitant

ipsilateral

foot

and

ankle

fractures.

Fractures

of

the

neck

of

the

talus

can

have

an

uncommon combination of concomitant ipsilateral foot

and

ankle

fractures.

One

should

have

a

high

index

of

suspicion

and

should

not

miss

these

concomitant

fractures.

For

early

recognition

and

prompt

simultaneous treatment, the preoperative assessment of

Talus fractures should be comprehensive.

CONFLICT OF INTEREST:

None

FUNDING SOURCES:

None

REFERENCES

1.

Saravi B, Lang G, Ruﬀ R, Schmal H, Südkamp N, Ülkümen S,

et

al. Conservative and surgical treatment of talar

fractures:

a

systematic review and meta-analysis on clinical outcomes and

complications.

Int

J

Environ

Res

Public

Health.

2021;18(16):8274.

doi:10.3390/ijerph18168274.

PMID:

34444022.

2.

Coltart

WD.

Aviator's

astragalus.

J

Bone

Joint

Surg

Br.

1952;34-B(4):545-566.

doi:10.1302/0301-620X.34B4.545.

PMID: 12999945.

3.

Jermander E, Sundkvist J, Ekelund J, Möller M, Wolf O, Mukka

S. Epidemiology, classiﬁcation, treatment and mortality of talus

fractures:

an

observational

study

of

1794

talus

fractures

from

the

Swedish

Fracture

Register.

Foot

Ankle

Surg.

2022;28(8):1444-1451.

doi:10.1016/j.fas.2022.08.008.

PMID:

36028442.

4.

Vallier HA, Reichard SG, Boyd AJ, Moore TA. A new look at

the

Hawkins

classiﬁcation

for

talar

neck

fractures:

which

features of injury and treatment are predictive of osteonecrosis?

J

Bone

Joint

Surg

Am.

2014;96(3):192-197.

doi:10.2106/JBJS.L.01680. PMID: 24500580.

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck

8

J Gandhara Med Dent Sci

October - December 2026

5.

Kumar

R,

Kumar

A,

Shanker

A,

Kumar

R.

Talar

fractures

treated with closed reduction and percutaneous screw ﬁxation. J

Orthop

Dis

Traumatol.

2023;6(3):213-217.

doi:10.4103/jodp.jodp_84_23.

6.

Al-Jabri

T,

Muthian

S,

Wong

K,

Charalambides

C.

Talus

fractures:

all

I

need

to

know.

Injury.

2021;52(11):3192-3199.

doi:10.1016/j.injury.2021.10.008. PMID: 34740388.

7.

Githens

M,

Tangtiphaiboontana

J,

Carlock

K,

Campbell

ST.

Talus

fractures:

an

update

on

current

concepts

in

surgical

management.

J

Am

Acad

Orthop

Surg.

2022;30(15).

doi:10.5435/JAAOS-D-20-01348. PMID: 35862213.

8.

Fournier A, Barba N, Steiger V, Lourdais A, Frin JM, Williams

T,

et

al.

Total

talar

fracture—long-term

results

of

internal

ﬁxation

of

talar

fractures:

a

multicentric

study

of

114

cases.

Orthop

Traumatol

Surg

Res.

2012;98(4

Suppl).

doi:10.1016/j.otsr.2012.04.012. PMID: 22621831.

9.

Srinath A, Southall WGS, Nazal MR, Mechas CA, Foster JA,

Griﬃn JT, et al. Talar neck fractures with associated ipsilateral

foot and ankle fractures have a higher risk of avascular necrosis.

J

Orthop

Trauma.

2024;38(6):220-224.

doi:10.1097/BOT.0000000000002798. PMID: 38457751.

10.

Jordan RK, Bafna KR, Liu J, Ebraheim NA. Complications of

talar

neck

fractures

by

Hawkins

classiﬁcation:

a

systematic

review.

J

Foot

Ankle

Surg.

2017;56(4):817-821.

doi:10.1053/j.jfas.2017.04.013. PMID: 28633784.

11.

Day MA, Compton JT, Buckwalter JA 5th. Leland G. Hawkins,

MD—his

life

and

orthopaedic

legacy:

talus

fractures

and

the

Hawkins

classiﬁcation.

Iowa

Orthop

J.

2018;38:1-8.

PMID:

30104918.

12.

Lindvall

E,

Haidukewych

G,

DiPasquale

T,

Herscovici

D

Jr,

Sanders

R.

Open

reduction

and

stable

ﬁxation

of

isolated,

displaced talar neck and body fractures. J Bone Joint Surg Am.

2004;86(10):2229-2234.

doi:10.2106/00004623-200410000-

00014. PMID: 15466732.

13.

Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK.

Reliability

and

validity

of

the

subjective

component

of

the

American

Orthopaedic

Foot

and

Ankle

Society

clinical

rating

scales.

J

Foot

Ankle

Surg.

2007;46(2):65-74.

doi:10.1053/j.jfas.2006.12.002. PMID: 17331864.

14.

Taş

SK,

Aydın

A.

Combined

ipsilateral

fracture

of

the

tibial

shaft,

lateral

malleolus,

and

talar

neck:

a case

report.

Trauma

Case

Rep.

2026;61:101315.

doi:10.1016/j.tcr.2026.101315.

PMID: 41909214.

15.

Kumar SV, Baskar AA, Sathyendra KG, Vasagan R, Solankey

RD,

Venkatesh R. A rare case of talus neck and open medial

malleolus fractures with ankle subluxation treated using a single

anteromedial

approach.

J

Orthop

Case

Rep.

2025;15(9):277-

281. doi:10.13107/jocr.2025.v15.i09.6098. PMID: 40936834.

16.

Zhang Y, Chen Y, Zhou K, Ma H, Zhu L. Talar neck fracture

combined

with

comminuted

medial

malleolar

fracture:

a

case

report.

Medicine

(Baltimore).

2025;104(45).

doi:10.1097/MD.0000000000045848. PMID: 41204519.

17.

Daryoush JR, Sato EH, Rothberg DL, Higgins TF, Haller JM,

Marchand LS. The combined talus and sustentaculum fracture: a

case

series.

Injury.

2024;55(10):111766.

doi:10.1016/j.injury.2024.111766. PMID: 39106534.

18.

Zhang J, Xu J, Yu J, Chen H, Hong X, Zhang S, et al. Predicting

the risk of postoperative avascular necrosis in patients with talar

fractures

based

on

an

interpretable

machine

learning

model.

Front

Bioeng

Biotechnol.

2025;13:1644261.

doi:10.3389/fbioe.2025.1644261. PMID: 40821667.

19.

Zhang C, Zhu J, Jia J, Guan Z, Sun T, Zhang W, et al. Eﬀect of

single versus multiple fractures on systemic bone loss in mice. J

Bone

Miner

Res.

2021;36(3):567-578.

doi:10.1002/jbmr.4211.

PMID: 33181861.

20.

Zheng J, Yao Z, Xue L, Wang D, Tan Z. The role of immune

cells

in

modulating

chronic

inﬂammation

and

osteonecrosis.

Front

Immunol.

2022;13:1064245.

doi:10.3389/ﬁmmu.2022.1064245. PMID: 36582244.

LICENSE:

JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (

CC-BY-NC-SA 4.0

).

COPYRIGHTS:

Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.

It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.

21.

Kondo T, Nakano Y, Adachi S, Murohara T. Eﬀects of tobacco

smoking

on

cardiovascular

disease. Circ

J. 2019;83(10):1980-

1985. doi:10.1253/circj.CJ-19-0323. PMID: 31462607.

22.

Sautet P, Roussignol X, Loubignac F, Rochwerger RA, Pidhorz

L;

Société

Française

de

Chirurgie

Orthopédique

et

Traumatologique

(SOFCOT).

Talar

fracture:

epidemiology,

treatment and results in a multicenter series. Orthop Traumatol

Surg Res. 2021;107(6):102835. doi:10.1016/j.otsr.2021.102835.

PMID: 33524630.

23.

Alley

MC,

Vallier

HA,

Tornetta

P

3rd;

Orthopaedic

Trauma

Research Consortium. Identifying risk factors for osteonecrosis

after

talar

fracture.

J

Orthop

Trauma.

2024;38(1):25-30.

doi:10.1097/BOT.0000000000002706. PMID: 37735752.

24.

Roddy

E,

Hannay

W,

Khilfeh

B,

Newell

K,

Dalstrom

D,

Sangeorzan

B,

et

al.

Long-term

functional

outcomes

after

modern

surgical

treatment

of

talus

fractures:

a

10-year

single

center

cohort

study.

Foot

Ankle

Int.

2025;46(11):1218-1228.

doi:10.1177/10711007251355611. PMID: 40922107.

25.

Lee

C,

Brodke

D,

Perdue

PW

Jr,

Patel

T.

Talus

fractures:

evaluation and treatment. J Am Acad Orthop Surg. 2020;28(20).

doi:10.5435/JAAOS-D-20-00116. PMID: 33030854.

26.

Lee

JY,

Ryu

JH,

Kook

JM,

Oh

JS.

Midterm

outcomes

after

operative management of Hawkins type III talar neck fractures.

Clin Orthop Surg. 2024;16(3):470-476. doi:10.4055/cios23391.

PMID: 38827753.

27.

Parmeshwar SS, Sharma SL, Sharma A, Shetty A, Kiran BM,

Patil

S.

A

comparative

study

of

three

diﬀerent

approaches

in

treatment

of

talar

neck

fractures.

J

Clin

Orthop

Trauma.

2022;37:102092.

doi:10.1016/j.jcot.2022.102092.

PMID:

36711112.

Faaiz Ali Shah

-

Concept & Design; Data

Acquisition; Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Final Approval

Aimal Sattar

-

Concept & Design; Data Acquisition;

Drafting

Manuscript;

Supervision;

Final Approval

Zia Ullah Jan

-

Concept & Design; Data Acquisition; Drafting

Manuscript;

Critical

Revision;

Final

Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Outcome of Open Reduction and Internal Fixation of Isolated Talus Neck