Pearls

• If dislocation present, reduce with knee flexion and ankle plantarflexion, followed by distraction and hindfoot inversion/eversion.
• Closed reduction should always be performed under conscious sedation if possible.
• May need to splint in plantar flexion to maintain reduction.
• Any displacement indicates the need for surgery. CT scans are reasonable to evaluate for displacement.
• Some dislocations may be associated with soft tissue blocks to closed reduction. This is an indication need for urgent open reduction.
• Canale view X-rays should be considered for optimum view of talar neck and talonavicular joint congruity, but may be difficult to obtain in acute setting.

Complications

Talar neck fracture-dislocation has high association with avascular necrosis and posttraumatic arthritis.