Hawkins' type-II talar fracture with subtalar dislocation: A very unusual combination

A rare case of floated talar head accompanying medial subtalar dislocation

INTRODUCTION AND IMPORTANCE

Concomitant medial subtalar dislocation and a rotated displaced talar neck fracture may result in poor outcomes. This study aimed to explain this extremely rare injury and assess the clinical outcomes following surgical treatment.

CASE PRESENTATION

A 22-year-old Iranian man referred to the emergency department with a gross deformity and pain in his right foot and ankle after a falling from 2 m. Plain radiographs showed a rotated free talar head accompanying medial subtalar dislocation. Closed reduction was performed in the emergency department under sedation. Prompt open reduction and internal fixation of talar fracture was done, after removal of free osseocartilaginous fragments in the subtalar and talonavicular joints. At 25 months postoperatively, the clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale and visual analogue scale for pain which were 73 and 3, respectively. In exam, the patient had a stiffed subtalar joint without talar osteonecrosis or collapse.

CLINICAL DISCUSSION

Several osseous and soft tissue barriers could prevent a successful closed reduction of a subtalar dislocation. Associated cartilage injuries or fractures may result in poor clinical outcomes such as persistent pain, limping, osteoarthritis, and osteonecrosis. Immediate open reduction and rigid fixation of associated fractures and resection of small free osseocartilaginous fragments may prevent further soft tissue damages and preserve clinical functions.

CONCLUSIONS

Satisfactory clinical outcome could be expected following proper on-time approach to a subtalar dislocation associated with a rotated displaced talar neck fracture.

Simultaneous Bilateral Fractures of the Tali

A 22-year-old male US Military Academy cadet fell while sidestepping across the 8-ft-high bar portion of the indoor obstacle course. The cadet, in immense pain, was unable to bear weight immediately after the fall. Following examination by physical therapists within the fitness center, emergency medical service personnel transported the cadet to the emergency department for definitive care. Radiographs demonstrated impaction fractures of the tali, while computed tomography imaging of his ankles demonstrated Hawkins type 2 fractures bilaterally, indicating talar neck displacement and dislocation of the subtalar joints. J Orthop Sports Phys Ther 2020;50(7):409. doi:10.2519/jospt.2020.9098.