Purpose <p>To compare clinical outcomes and complication rates between plate with independent screw fixation versus screw fixation alone in the management of talar neck fractures (AO/OTA 81.2), with a primary focus on avascular necrosis (AVN).</p> Methods <p>A retrospective review was performed of adult patients who underwent operative fixation of talar neck fractures at a single Level I trauma center between 2017 and 2022, with a minimum follow-up of 3&#xa0;months. Patients were divided into screw fixation alone (S) and plate with independent screw fixation (PS) groups. The primary outcome was avascular necrosis (AVN). Secondary outcomes included fracture union, post-traumatic arthrosis (PTA), infection, and unplanned reoperation. Multivariable logistic regression was performed to identify factors associated with AVN.</p> Results <p>Seventy patients were included (33 S, 37 PS) with no differences in baseline demographics, comorbidities, or injury characteristics (<i>p</i> &gt; 0.05). Union rates were similar between groups (<i>p</i> = 0.23). The incidence of AVN was significantly higher in the S group compared to the PS group (52% vs 22%, <i>p</i> = 0.01). There were no differences in rates of PTA, infection, or reoperation (<i>p</i> &gt; 0.05). On multivariable analysis, plate fixation was associated with a significantly lower likelihood of AVN (OR 0.16, 95% CI 0.03–0.70; <i>p</i> &lt; 0.01).</p> Conclusion <p>In this retrospective cohort, plate with independent screw fixation was associated with a significantly lower risk of avascular necrosis compared to screw fixation alone in talar neck fractures, while maintaining similar union and complication rates</p>