The talus is the keystone of the ankle mortise, transmitting body weight from the tibia to the foot. It has no muscle attachments — all forces are transmitted through its ligamentous and articular connections. Sixty percent of its surface is covered by articular cartilage. Its blood supply is entirely retrograde through foramina on the neck and sinus tarsi — talar neck fractures interrupt this supply and produce AVN in 15-50% of cases depending on displacement.
Talar neck fractures (Hawkins classification: Type I undisplaced, Type II subtalar dislocation, Type III total dislocation, Type IV with talonavicular dislocation) have increasing AVN rates with displacement. Types II-IV require urgent closed or open reduction and internal fixation. Hawkins sign (subchondral osteopenia at 6-8 weeks) indicates preserved vascularity — its absence warrants MRI for AVN assessment.
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