Percutaneous reduction and screw fixation of fracture neck talus.

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Abstract

[Indexed for MEDLINE] 9. J Foot Ankle Surg. 2017 Nov-Dec;56(6):1288-1291. doi: 10.1053/j.jfas.2017.05.007. Epub 2017 Aug 1. Low-Energy Hawkins Type III Talar Neck Fracture-Dislocation With Neurovascular and Tendon Entrapment in a Pediatric Patient. Kızılay YO(1), Aytan O(2). Author information: (1)Orthopedics and Traumatology Surgeon/Specialist, Turan & Turan Bone and Joint Surgery Clinic, Osmangazi, Bursa, Turkey. Electronic address: onurkizilay@yahoo.com. (2)Orthopedics and Traumatology Surgeon/Specialist, Turan & Turan Bone and Joint Surgery Clinic, Osmangazi, Bursa, Turkey. Several serious complications can occur after talar neck fractures. However, these fractures are extremely rare in children. We present a pediatric low-energy Hawkins type III fracture-dislocation that had excessive displacement accompanied by neurovascular and tendon entrapment. A 9-year-old male patient referred to our hospital 5 hours after jumping off a swing in a children's playground. An excessively displaced talar neck fracture-dislocation was observed at the initial evaluation. The patient underwent urgent surgery. The tibialis posterior flexor digitorum longus tendons, posterior tibial artery, and tibial nerve were entrapped at the fracture site. The talar neck fracture was reduced using open reduction. The neurovascular structures and tendons were removed from the fracture site. The fracture was fixed using two 4.5-mm cannulated screws. The patient was able to bear full weight at 10 weeks postoperatively. At 6 months, the patient was able to walk unassisted with full ankle range of motion. However, at 2 years, his American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score had decreased to 72 points, and we observed avascular necrosis in the talar head. In conclusion, talar fractures are rare but can lead to serious complications. In the pediatric population, even low-energy trauma, such as had occurred in our patient, can result in severe displaced fracture-dislocations. After severe displaced fracture-dislocations, important soft tissue structures can become entrapped between fracture fragments, and surgeons should be aware of this situation when considering using closed reduction. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved. DOI: 10.1053/j.jfas.2017.05.007