The talar neck is the constricted segment of the talus between the head anteriorly and the body posteriorly. It is directed medially and plantarward relative to the talar body, with the angle of declination approximately 15-20 degrees in the frontal plane. The superior surface of the neck is extraarticular and the primary site of blood vessel entry into the talus. The sinus tarsi lies between the inferior surface of the talar neck and the calcaneus.
Talar neck fractures (Hawkins fractures) result from forced dorsiflexion, typically in high-energy trauma. The Hawkins classification grades neck fractures by displacement and predicts AVN risk: Type I (undisplaced, 0-13% AVN), Type II (subtalar subluxation, 20-50% AVN), Type III (subtalar and tibiotalar dislocation, 20-100% AVN), Type IV (pantalar dislocation, nearly 100% AVN). The Hawkins sign, a subchondral lucency in the talar dome on 6-8 week X-ray, indicates revascularisation and predicts a lower AVN risk.
High-energy forced dorsiflexion fractures the talar neck, with AVN risk proportional to fracture displacement; urgent anatomic reduction and fixation is required to minimise AVN risk, and the Hawkins sign on follow-up radiograph assesses revascularisation of the talar body.
Repetitive anterior ankle impingement from forced dorsiflexion in athletes produces osteophyte formation on the anterior talar neck and dorsal plafond, causing impingement pain at end-range dorsiflexion managed by arthroscopic osteophyte debridement.
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