Posterior talar fracture with dislocation of both talo-navicular and subtalar joints: a variant type II of the Sneppens classification

Talar body and posterior talar process fracture combined with peritalar luxation (clinical case)

The uniqueness of this clinical case is due to a rare combination of peritalar luxation of the talus with a fracture of its body and posterior process. No description of the same clinical case was found in the literature, however, it has been proven that such injuries have an unfavorable prognosis and are fraught with multiple complications. Also, the limited information associated with the low inci-dence of this type of severe injury puts practitioners in front of the difficulties of diagnosis and treatment. A 35-year-old man was injured while playing basketball. Upon admission, computed tomography (CT) revealed a fracture of the body of the talus with displacement of the distal fragment and its dislocation in the talonavicular, subtalar and talo-tibial joints, as well as a fracture of the posterior process of the talus. After an unsuccessful attempt at closed reduction, open removal of the dislocation and reposition of fragments were per-formed, followed by osteosynthesis of the fracture of the body of the talus. In the postoperative period, additional immobilization in the ANF was performed, followed by replacement with a functional orthosis. 6 months after the injury, the patient restored the level of his daily activities almost completely, the control CT showed no signs of post-traumatic arthrosis of the subtalar and ankle joints, how-ever, there were signs of the development of partial aseptic necrosis of the talus. This injury is unique, and despite its severity, the use of the correct treatment tactics can provide a satisfactory clinical and functional outcome.

Talar Body Fracture With Closed Pan-Talar Dislocation

Talar body fracture associated with pan-talar (tibiotalar, talocalcaneal, talonavicular) dislocation is a rare condition. Timely intervention with anatomical reduction will lead to better healing of the fracture. It will result in articular congruity of the talus and less chance of secondary arthritis. We describe a rare talar body fracture with pan-talar dislocation, which does not fit into any of the classifications mentioned in the literature.

A young male of 21 years old was admitted to the trauma and emergency department of a tertiary care hospital within three hours of injury. Following the radiological investigations, the patient was found to have a talar body fracture with pan-talar dislocation. Initially, a close reduction was attempted which failed. Subsequently, it was managed with open reduction and internal fixation after eight hours of injury. Talar body fracture was fixed with cannulated cancellous screws and ankle stabilized with joint spanning external fixator. At six months the patient had satisfactory healing of fracture without any irregularity of the articular surface of talus or arthritic changes of involved joints.

Early surgical intervention with anatomical reduction of talar body fracture with pan-talar dislocation may lead to better union and less chance of secondary arthritis of peri talar joints.