Use of Ilizarov Device to Gain Early Range of Motion in the Treatment of Pediatric Talus Body Fractures: A Series of Four Cases and Literature Review

Abstract

Background: Talus fractures are rare in children but can lead to severe outcomes if untreated. The Ilizarov external fixator has been used in the treatment of a variety of lower extremity pathologies. The purpose of this study was to investigate the clinical outcomes of talus body fractures treated with the Ilizarov external fixator.

Case presentation: Four male pediatric patients (age range, 5-11 years) with talus body fractures who were treated by open reduction and internal fixation combined with Ilizarov external fixator between November 2015 and April 2016 were reviewed. Mean follow-up period was 4 years (range, 4-5). Clinical outcome was evaluated using the clinical rating scale of the American Orthopaedic Foot and Ankle Society (AOFAS). All four patients achieved good to excellent results at the last follow-up. None of the patients developed avascular necrosis. One patient developed automatic fusion of tibiotalar joint.

Conclusion: Use of the Ilizarov external fixator to gain early range of motion is a valuable option for treatment of talus body fractures in children.

Keywords: Ilizarov device; children; internal fixation; open reduction; talus body fracture.

Fig. 1

Preoperative three‐dimensional reconstruction of computed tomography images of a 9‐year‐old boy with Sneppen type V fracture of left talus body sustained after a fall (A, B). Postoperative anteroposterior (C) and lateral (D) X‐ray views showing open reduction with combined screws and K‐wires fixation with a Ilizarov frame to reduce the longitudinal pressure on left talus. Anteroposterior (E) and lateral (F) X‐ray views at 5 months postoperative. The Ilizarov frame had been removed at 3 months after operation and talus fracture shows union with no signs of avascular necrosis. At 4 years after operation, anteroposterior (G) and lateral (H) X‐ray views show a bone bridge of distal medial tibia with varus ankle; however, there are no signs of avascular necrosis or osteoarthritis after removal of the screws and K‐wires at 10 months after surgery

Fig. 2

A schematic illustration of the Ilizarov device. Four rings (two tibial rings, one foot ring, and one forefoot ring) were attached to one another with connecting rods

Fig. 3

At 4‐year follow up after surgery, mild varus of left ankle is observed (A, B), with moderate restriction of left ankle joint flexion (C, D)