Forty fractures and fracture-dislocations of the neck of the talus are reviewed. Undisplaced fractures are associated with a high proportion of good results. Type n fractures, where there has been subluxation of the subtalar joint, require accurate reduction to avoid subtalar joint incongruity, and have a 20% incidence of avascular necrosis. Type III fractures, with dislocation of the body of the talus, have a poor prognosis and have a 100% incidence of avascular necrosis. Hawkins' sign of subcortical radiolucency is helpful in ascertaining the presence or absence of avascular necrosis. Accurate open reduction and rigid internal fixation with early range of motion of the involved joints is recommended where a closed reduction has failed to provide anatomic reduction.