Unusual ankle fracture: A case report and literature review

A rare combination of talar neck fracture (Hawkins 3) and bimalleolar ankle fracture: A case report

INTRODUCTION

The combination of talar neck fractures with malleolar fractures is a rare. This rare association accounts for 0.3 % of all bone fractures. We describe a one-of-a-kind ankle dislocation with a talar neck fracture and a bimalleolar fracture.

CASE PRESENTATION

A 24-year-old male patient presented to the emergency department after a traffic accident. A physical examination revealed swelling and tenderness in the left ankle. The radiograph and the CT scan showed a Hawkins type III comminuted talar neck fracture, with an oblique fracture of the medial malleolus and an infra-syndesmotic fracture of the lateral malleolus. The patient underwent open reduction and internal fixation involving screw fixation for talar neck fracture and the medial malleolus and plating for the lateral malleolus. The treatment and post-operative follow-up showed successful healing and functional recovery, with a score of 85 on the American Orthopedic Foot and Ankle Society ankle-hindfoot at the last follow up.

DISCUSSION

The discussion includes insights on the rarity of this fracture combination, treatment challenges, and potential complications such as avascular necrosis. This article emphasizes the importance of achieving anatomical reduction and stable fixation for optimal outcomes in such complex fractures.

CONCLUSION

This case report highlights the successful treatment of a rare combination of talar neck and bimalleolar ankle fractures, emphasizing the importance of anatomical reduction and stable fixation for optimal outcomes in complex fractures.

Physiotherapy Management Focusing on Early Mobilisation in Complex Pelvic and Pott's Fracture

Pelvic fractures (PFs), involving the disruption of the bony structures in the pelvic region, are complex injuries often associated with high-energy trauma. Such fractures can significantly impact a patient's mobility and overall quality of life. Concurrently, fractures of the malleoli, specifically the lateral and medial aspects of the ankle, are common lower extremity injuries that can result from various mechanisms, including twisting or direct trauma. This case report presents the multidisciplinary approach employed in the successful treatment of a 26-year-old male patient with a rare combination of PFs involving both anterior and posterior columns, along with lateral and medial malleolus fractures. The patient underwent a series of surgical interventions to stabilise the fractures, followed by a tailored physiotherapy management plan. The report discusses the postoperative care strategies and the crucial role of physiotherapy in the rehabilitation process.

Atypical Talus Fracture: A Case Report

Introduction

Talus fractures are relatively rare injuries. These injuries are very serious because they can compromise the motion of foot and ankle and result in severe disability. Fractures of talar neck and body constitutes about 40% of all talus fractures. These occur secondary to high energy trauma most commonly motor vehicle collisions or fall from height. Fractures involving the lateral process results due to ankle inversion and dorsiflexion. Majority of talar surface is covered by articular cartilage and its role in force transmission between leg and foot makes successful treatment of such injuries a mandatory prerequisite to regain function. We present an atypical case of talus fracture in which fracture plane extends from posterior aspect of lateral talar process involving the body in coronal plane. Not much of literature has been published in this regard.

Case Report

A 28 year old male presented with pain in the left ankle following fall from a tree. Following the radiological investigations, in coronal plane fracture line extends from posterior aspect of lateral talar process into the body medially and anteriorly. Internal fixation of the fracture was done by an open approach and a strict rehabilitation protocol was followed. At three months the patient had satisfactory healing of fracture without any irregularity of the articular surface and ambulant pain free with full range of ankle movements.

Conclusion

There are several choices to treat talar fractures. The ideal treatment should be customized as per the fracture morphology. Open reduction and internal fixation is one of the best options to restore the tibiotalar and subtalar joint congruency and to prevent post traumatic arthritis. Appropriate diagnosis and perioperative treatment is the key to success in talar fracture management.

A combination of bimalleolar fracture and fracture on talar body and neck: A rare case report

RATIONALE

Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture.

PATIENT CONCERNS

A 57-year-old man presented at the emergency department following a motorcycle accident.

DIAGNOSES

Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation.

INTERVENTIONS

We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction.

OUTCOMES

The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling.

LESSONS

This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.

A rare combination of closed fracture of right talar body Sneppen 2 with associated medial malleolus: A case report

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Talar fractures are uncommon.

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Anatomic and stable reduction of talar fractures is of paramount importance.

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ORIF plate screw and ORIF TBW can be used to treat talar fracture.

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Good prognosis can be achieved by ORIF plate screw and ORIF TBW.

Introduction

Ankle fractures are common, with the incidence of up to 174 cases per 100,000 adults per year. The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The combination of talar body fracture in sagittal plane along with medial malleolus fracture is an unusual pattern of injury and rarely reported in the literature.

Presentation of case

We presented a case of nineteen-year old male with pain on the right ankle as a result from motorcycle accident twelve hours before admitted to Cipto Mangunkusumo Hospital. After the patient underwent close reduction and immobilization using back slab, patient then underwent open reduction surgery of the right ankle then fixated using plate and screw combined by tension band wiring (TBW) at the right medial malleolus.

Discussion

Talar and Medial malleolus fracture was initially evaluated by physical examination and radiographic imaging and classified by Sneppen classification. After the diagnosis was established the patient underwent ORIF plate, screw and tension band wiring. In post-operative x-ray examination, there was a significant improvement in talocrural angle and medial clear space but same result in tibiofibular overlap and tibiofibular.

Conclusion

Open reduction and internal fixation (ORIF) plate and screw combined by tension band wiring (TBW) is the right surgical treatment for patient with closed fracture of right talar body Sneppen 2 with associated medial malleolus fracture. The outcome of the treatment is excellent because the patient presented was able to fully recover to normal activity.

Talar Neck Fracture with Dislocation Combined with Bimalleolar Ankle Fracture: A Case Report

BACKGROUND Fractures of the talus are uncommon injuries that usually involve the talar neck, rather than the talar body. This report is of a rare case of combined left talar neck fracture and adjacent joint dislocation with an ipsilateral bimalleolar ankle fracture. CASE REPORT A 37-year-old man presented with an injury to his left foot following a motor vehicle accident. When he presented to the hospital emergency department, his left foot and ankle were swollen, the overlying skin was intact but badly contused, and there was no neurovascular deficit. Radiographs of the left ankle showed a fracture of the talar neck and bimalleolar fracture. An initial closed reduction under anesthesia failed. Therefore, open reduction and rigid stabilization of all fractures were achieved surgically, followed by the application of an external fixator spanning the ankle and the subtalar joints. The external fixator was removed at six weeks, range of motion (ROM) exercises were commenced, and a non-weight-bearing mobilization protocol was continued for 12 weeks. At four-year follow-up, radiographs confirmed solid union of all fractures, and although avascular necrosis (AVN) of the talus and secondary ankle arthritis developed, the functional outcome was satisfactory. CONCLUSIONS The immediate management of talar neck fracture with dislocation combined with a bimalleolar fracture is important to prevent soft tissue complications and to improve the functional ROM of the ankle. However, AVN and post-traumatic osteoarthritis at both the ankle and the subtalar joints are still common sequelae of talus fracture.

A rare combination of sagittal plane fracture of talar body with medial malleolus fracture: Case report and review of literature

Fractures of talus are relatively uncommon injuries with majority of them involving the neck region. Talar body fracture in sagittal plane in combination with medial malleolus fracture is very rare with few cases being reported in the literature earlier. We report such an unusual combination in an adolescent, which was treated with open reduction and internal fixation with screws for both talus and medial malleolus. This was followed by physiotherapy and non-weight bearing till the fracture united.