Introduction and purpose: Talar fractures are infrequent but are an important cause of morbidity.

Materials and methods: This is a retrospective study of talar fractures treated in our Hospital between 1997 and 2006 (10 years).

Results: We collected 44 fractures in 42 patients (37 men and 5 women), with a mean age of 33 years (range: 8–67 years). The cause of the fractures in 40 cases was high-energy trauma and in 4 cases low-energy trauma. The most frequent causes were traffic accidents (29) and falls (8). Mean hospital stay was 14 days. We found 22 neck fractures, which were classified accoding to Hawkins’ scale (10 type I, 9 type II and 3 type III), 19 fractures of the body (7 due to crushing, 5 coronal, 4 osteochondral, 2 sagittal and 1 of the lateral process), and 3 combined neck and body fractures. We did not see any head fractures. We found 5 fracture-dislocations, 2 subtalar fractures associated to a neck fracture and 2 complete dislocations. Nine of the 44 fractures were open (1 grade I, 5 grade II, 2 grade IIIA, 1 grade IIIB). Only 9 of the 42 patients did not have associated lesions. Of those that did have associated lesions, 52% had adjacent lesions and 57% had distant lesions. Twenty-six fractures underwent surgery, 20 with cannulated screws (6 anterograde and 14 retrograde) and 6 with Kirschner wires. Follow-up was carried out in 24 of these patients and the complications seen were 2 osteonecrosis, 5 skin necroses, 12 cases of posttraumatic arthritis, 3 infections, 2 malunions, and 8 cases of intolerance of osteosynthesis material. Hawkins’ sign was assessed in the neck fractures, and osteopenia was found in 6 fractures, none of which developed osteonecrosis. In the 3 patients who did not have osteopenia, 2 ischemic necroses were seen.

Conclusions: The rate of osteonecrosis was 13% in the patients followed up, less than that seen in published series. A positive Hawkins’s sign is reassuring as none of the patients with subchondral osteopenia at 6–8 weeks subsequently developed osteonecrosis.