Painful Ununited Fracture of the Posterior Process of the Talus in an Adolescent Dancer: A Case Report

Paediatric talus fractures: A guide to management based on a review of the literature

BACKGROUND

Talus fractures are devastating injuries in both adults and children. Well recognised complications such as avascular necrosis (AVN), post-traumatic arthritis and non-union contribute to patient morbidity. This systematic review aimed to assess the literature on these injuries in children and their associated incidence, classification, management and outcome.

METHODS

A systematic review of Embase and Medline databases was carried out in accordance with PRISMA guidelines. Inclusion criteria were clinically orientated studies looking at talus fractures in paediatric patients (less than 18 years old). Exclusion criteria were conference abstracts, opinion-based reports, articles not published in English and articles published prior to 1980. Data extracted included patient demographics, fracture classification, management and outcomes.

RESULTS

31 studies were included encompassing 143 patients and 167 fractures with a mean age of 11.9 years (1.2-18). The majority of fractures (43.7%, n = 73) were of the talar neck. 70.6% (n = 101) were managed operatively. The overall rate of AVN was 15.4% (n = 22), with a 96.5% union rate. Observed rates of AVN were 5.7% in Hawkin's 1, 11.8% in Hawkin's 2, 53.3% in Hawkin's 3 and 0 in Hawkin's 4 injuries. All cases of non-union occurred in children over 12 years, and seven children required arthrodesis (1x pantalar, 1x subtalar and 5x subtalar and tibiotalar) with a mean age of 14.4 years (9-17).

CONCLUSIONS

Talus fractures are rare but potentially devastating injuries in children. This systematic review has shown comparable rates of AVN in children to their adult counterparts, with higher rates of non-union and arthrodesis in adolescent patients. A lower threshold for operative intervention to achieve anatomical reduction in these patients should be considered.

Fracture of the Entire Posterior Talar Process in an Adolescent Boy: A Case Report

CASE REPORT

Fractures of the talus in adolescents are uncommon and usually involve the talar body or neck. We report a rare fracture of the entire posterior talar process in a 14-year-old boy who fell during skateboarding. He was managed with open reduction and fixation with a headless screw. He gradually regained sports activities after 4 months and had no further complaints at his last follow-up evaluation, 18 months postoperatively.

CONCLUSION

In posterior talar process fractures, operative treatment can provide a good functional outcome. Patients must be followed with serial radiographs because of the high incidence of nonunion and avascular necrosis.

Rare injury of the foot: Os trigonum fracture: A case report

Os trigonum fractures are seen rarely. Our patient was a 16-year-old male patient who applied to our emergency service with right ankle pain due to acute hyperplantar flexion while playing football. There was a swelling on the right ankle and he had difficulty in walking. Os trigonum fracture was detected at lateral X-ray of the right ankle. No additional injury was detected with computed tomography and magnetic resonance imaging (MRI). Patient was treated conservatively. A short leg cast was applied. Cast was removed after six weeks and range of motion exercises were started. Union of fracture was seen on X-ray at six weeks from injury. Conservative treatment is thought to be a good option in these fractures. Computed tomography and MRI are important in the differential diagnosis and evaluation of additional injuries in this type of fracture.

Medical attention seeking dance injuries: systematic review of case reports

The objective of this study was to conduct a systematic review of case reports documenting the epidemiology of unique and rare musculoskeletal injuries in dancers. A systematic review was conducted online using PubMed and Google Scholar, as per PRISMA guidelines up to July 30, 2016. Predefined eligibility criteria were applied, and the data thus compiled was analysed. Study quality was assessed based on CARE guidelines. 72 studies reporting 92 dance injuries were included in the review. The average age of dancers was 23 years (SD = 10 years) with majority being females (65%). Chronic injuries were the most common presentation with lower extremity injuries being the commonest. Foot and knee injuries were the top two articulations involved across injuries and groups. Overall bony injuries were most frequently reported, with stress injury being the most common type. Conservative approach was the most commonly reported treatment approach across case reports. The methodological quality of case reports included in the study varied considerably and lacked uniformity. The evidence provided, though not sufficient for any recommendation, it should alert the physicians and those concerned with the primary care of the dancers to be vigilant of the eccentricity and severity of the injuries, their atypical presentation, mode, mechanism and trend, thereby being prepared for the unexpected.