Surgical management of displaced talus neck fractures: single vs double approach, screw fixation alone vs screw and plating fixation–systematic review and meta-analysis

•Despite its relative rarity, talus neck fractures are dramatically complicated by the articular nature of the whole bone and the tenuous blood supply network that perfuses it.•Nowadays, displaced talus neck fractures are preferably managed by combined dual approaches that allow reduction of both medial and lateral sides of the talus, and interfragmentary compression of the non-comminuted facture lines and anatomic alignment and length of the comminuted fracture lines.•There is a significant correlation between poor scores and poor fracture reduction, but not with the modified Hawkins classification, surgical approach, and fixation strategy.•Avascular necrosis and post-traumatic osteoarthritis are significantly more common after combined approaches•The overall avascular necrosis and post-traumatic osteoarthritis event rate was 0.279 and 0.400, respectively. To provide a direct comparison between two important aspects related to talar neck fractures management – surgical approaches and fixation strategies. A systematic review and meta-analysis was performed using PubMed, SciELO, and gray literature databases. The keyword “talus fracture” and the combined terms “talus neck fracture AND surgical approach” and “talus neck fracture AND fixation strategy” were used. Study selection, data extraction, and the risk of bias assessment were performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were limited to human studies and the English and Portuguese. Inclusion criteria were articles in full text that reported on any aspect of surgical approach and fixation strategy for talus neck fractures. Exclusion criteria were skeletally immature patients, mean follow-up of less than 12 months, studies that did not use the Hawkins classification system, primary treatment of arthrodesis, studies published before year 2000, and studies published in languages other than English and Portuguese. Basic information was collected including journal, author(s), year published, level of evidence, number of fractures, and follow-up. Specific information was collected including fracture classification, surgical approach, fixation strategy, complication rate, type of complication(s), and outcome measurement(s). Fixed-effects model was used for meta-analysis. The choice for surgical approach(es) and fixation strategy was stratified based on fracture classification. Complication rate, type of complication(s), and outcome meas