Abstract
Several serious complications can occur after talar neck fractures. However, these
fractures are extremely rare in children. We present a pediatric low-energy Hawkins
type III fracture-dislocation that had excessive displacement accompanied by neurovascular
and tendon entrapment. A 9-year-old male patient referred to our hospital 5 hours
after jumping off a swing in a children's playground. An excessively displaced talar
neck fracture-dislocation was observed at the initial evaluation. The patient underwent
urgent surgery. The tibialis posterior flexor digitorum longus tendons, posterior
tibial artery, and tibial nerve were entrapped at the fracture site. The talar neck
fracture was reduced using open reduction. The neurovascular structures and tendons
were removed from the fracture site. The fracture was fixed using two 4.5-mm cannulated
screws. The patient was able to bear full weight at 10 weeks postoperatively. At 6
months, the patient was able to walk unassisted with full ankle range of motion. However,
at 2 years, his American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score
had decreased to 72 points, and we observed avascular necrosis in the talar head.
In conclusion, talar fractures are rare but can lead to serious complications. In
the pediatric population, even low-energy trauma, such as had occurred in our patient,
can result in severe displaced fracture-dislocations. After severe displaced fracture-dislocations,
important soft tissue structures can become entrapped between fracture fragments,
and surgeons should be aware of this situation when considering using closed reduction.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 01, 2017
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
