Talar neck fracture with talar head dislocation and intact ankle and subtalar joints--a rare case report

Fracture neck of the talus with isolated talonavicular dislocation: A case report

INTRODUCTION

Talar neck fractures are injuries which frequently result in adverse outcomes or impairment of functional activity. Four groups were identified according to Hawkins classification and Canale modification. We present a female patient with a fractured neck of the talus associated with talonavicular dislocation, but intact tibiotalar and subtalar joints; an injury pattern not fulfilling the criteria described in the Hawkins classification.

PATIENT CONCERNS

A 46-year-old woman missed a step and fell down stairs with an immediate painful right ankle and inability to bear weight.

DIAGNOSIS

Talar neck fracture with an unusual isolated talonavicular dislocation.

INTERVENTIONS

Temporary closed reduction followed by open reduction and internal fixation were performed.

OUTCOMES

The patient had excellent functional and radiological outcomes following surgical management.

CONCLUSION

We discuss the management of this rare case in addition to a review of the current literature to provide the best evidence-based recommendations for this injury pattern.

Simultaneous Bilateral FractureUnilateral Dislocation of the Talus

In this study, we present the case of a 42-year-old man with a fracture and dislocation of the left talus neck, and a fracture of the right talus neck due to a fall. This kind of fracture can be considered rare, and thus few cases have been reported. Fracture fixation was provided through cannulated screws on either side. Splints were removed after 6 weeks, and passive/active joint movement exercises were started. The patient was able to walk with partial weightbearing at 2 months and with full weightbearing at 3 months. The magnetic resonance imaging scan at 1 year postoperatively revealed the presence of avascular necrosis on the left, whereas it did not exist on the right. Range of motion in both of the ankles was satisfactory. The patient expressed that he was able to perform daily activities without any difficulty and run for 30 minutes without pain. In this case report, in addition to providing a review of the relevant literature on the subject, we set out to show the importance of rigid fixation and early mobilization in these rare injuries.

Sonographic diagnosis of a medial talar avulsion fracture

Occult talus fractures can be easily misdiagnosed as simple ankle sprains, resulting in painful nonunion, arthrosis, avascular necrosis, and long-term disability. We present a case of ankle injury with medial talar fracture that was negative on plain radiography but was diagnosed with sonography. Sonography is a valuable tool in screening ankle sprains and may assist clinicians in diagnosing the nature of ankle injury, thus guiding the most appropriate therapeutic strategy.

Talar neck fracture associated with talonavicular dislocation and fracture of posteromedial process of talus

Canale and Kelly modified the Hawkins classification of talar neck fractures by adding a type IV fracture dislocation to the original 3 types described. Type IV injury occurs rarely and is the only type involving dislocation of the talonavicular joint. To our knowledge, only 2 unusual cases have been described in published studies in which a fracture of neck of the talus occurred in association with talonavicular dislocation but the ankle and subtalar joints remained intact. We describe a very unusual case of an adult male with a fracture of the neck of the talus with talonavicular dislocation, subtalar subluxation, an intact ankle joint, and a fracture of the posteromedial tubercle of talus. Open reduction and internal fixation of the talar neck and posteromedial tubercle was undertaken. The talar neck fracture united without any evidence of avascular necrosis, but the posteromedial tubercle remained un-united. Such an injury is unusual, and the injury pattern is unique and cannot be classified using existing systems.