A Method of Open Reduction of an Irreducible Hawkins Type III Fracture of the Talar Neck.

Hawkins type III fracture talar neck may sometimes be a nightmare for surgeons to reduce, even intraoperatively. It is difficult to reduce as the talar body is locked into its dislocated posteromedial position out of both the ankle and subtalar joint. Maneuvers of reduction have been described both in dorsiflexion and plantarflexion of ankle, but these are complicated and not tissue friendly. Further, various methods of grasping and pushing the dislocated talar body by use of joysticks and distractors have been advocated. To accomplish this intraoperatively, we present a convenient and utilitarian method using only 2 smooth 1.5-mm Kirschner wires and a JESS distractor clamp. Two key concepts to keep in mind while reducing such fracture dislocations are also highlighted. This was done in a 22-year-old male with 7-day-old Hawkins type III fracture of the left talar neck and a right Pilon fracture with good results at 2 year follow-up.