Surgical Management Protocol of Hawkins Type 3 Comminuted Fracture Neck of Talus Case Series.

INTRODUCTION

Talus fractures are uncommon, accounting for <1% of all fractures, but they are clinically significant due to their high propensity for complications, such as avascular necrosis, post-traumatic arthritis, and non-union. The talus has a complex anatomy and a tenuous blood supply, making it particularly vulnerable to healing complications when not managed appropriately. Non-union of talus fractures is rare and often results from inadequate initial treatment, especially in displaced fractures that are managed conservatively.

CASE REPORT: We report the case of a 34-year-old male who sustained a talar body fracture following a high-velocity road traffic accident. The patient was initially managed conservatively with immobilization but presented 6 months later with persistent pain, swelling, and difficulty in weight-bearing. Clinical examination and imaging, including computed tomography scan, revealed a non-union of the talar body fracture with sclerotic margins. Considering the chronicity and symptoms, surgical management was planned. The patient underwent open reduction and internal fixation (ORIF) through an anteromedial approach using two 4.0 mm cannulated cancellous screws. The fracture site was debrided, reduced anatomically, and fixed in a stable construct. Post-operatively, the patient was immobilized and kept non-weight-bearing, followed by a structured rehabilitation protocol.

CONCLUSION

At follow-up, the patient showed significant clinical improvement, with radiological union observed by 3 months and full return to daily activities by 6 months. This case underscores the importance of accurate diagnosis, appropriate treatment planning, and timely surgical intervention in managing talus fractures to avoid complications, such as non-union. ORIF using cannulated cancellous screws proved to be a safe and effective treatment modality, even in delayed presentations.