Challenges in Talus Fracture-dislocations - A Case Report

Abstract

Introduction: Fractures of the talus and its associated hindfoot dislocations are uncommon. They usually result from high-energy trauma. These fractures can lead to permanent disability. Optimal treatment relies on accurate evaluation of the injury with proper imaging to identify the fracture pattern and associated injuries and to be able to make an appropriate pre-operative plan. Avoiding soft-tissue complications, avascular necrosis, and post-traumatic arthrosis are the main goal of treatment.

Case report: We report a case of concomitant left talar neck and body fracture associated with a fracture of the medial malleolus in a 46-year-old male. We performed a closed reduction of the subtalar joint followed by an open reduction internal fixation of the talar neck/body and medial malleolus fractures.

Conclusion: At 12 weeks following the treatment, the patient had good movement with minimal discomfort on dorsiflexion, he was able to ambulate with no limp. Radiographs showed appropriate healing of the fracture. The patient was able to go back to his work with no restrictions as of publication of this report. Talus fracture dislocations are not benign in nature. Meticulous attention to soft-tissue management, anatomic reduction and fixation as well as adequate post-operative follow-up is needed to obtain a satisfactory outcome and avoid the detrimental sequalae of avascular necrosis and post-traumatic arthrosis.

Keywords: Talus fracture dislocation; anatomic reduction; avascular necrosis; outcome; post-traumatic arthritis; return to work.

Figure 1

(a) Hawkins-classifications-CITATION-Ska22-\l-1033-(b) Hawkins-illustration-CITATION-And22-\l-1033. Skalski, M. Hawkins classification of talar neck fracture-illustration. Case study, Radiopaedia.org. (accessed on 02 Nov 2022) Table 1 Fractures of the Talus: Current Concepts-Scientific Figure on Research Gate. Available from: https://www.researchgate.net/figure/The-Hawkins-Classification-of-Talar-Neck-Fractures_tbl2_339260284.

Figure 2

The displaced talar neck and body with subtalar dislocation (a) computed tomogrphy (CT) showing Sagittal 3 D view (b) CT showing the sagittal view.

Figure 3

Subtalar intraoperative reduction.

Figure 4

Computed tomography of the postoperative reduction.

Figure 5

Intraoperative open reduction and internal fixation.

Figure 6

2 weeks X-rays postoperative anterior view.

Figure 7

6 weeks X-rays postoperative anterior view.

Figure 8

12 weeks X-rays postoperative anterior view.