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UNUSUAL TALUS FRACTURE IN CHILDREN

Talus fracture are extremely rare in children. The talus is predominantly made up of cartilage with higher elastic resistance than adult bone thus the pediatric talus bone can sustain higher forces before fractures. The prevalence for paediatric trauma in talus fracture is estimated to be five times...

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Autores principales: Zulfahrizzat, S, Nadzim, AS, Norshaidi, S, Abdul, Rauf A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262831/
http://dx.doi.org/10.1177/2325967120S00033
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author Zulfahrizzat, S
Nadzim, AS
Norshaidi, S
Abdul, Rauf A
author_facet Zulfahrizzat, S
Nadzim, AS
Norshaidi, S
Abdul, Rauf A
author_sort Zulfahrizzat, S
collection PubMed
description Talus fracture are extremely rare in children. The talus is predominantly made up of cartilage with higher elastic resistance than adult bone thus the pediatric talus bone can sustain higher forces before fractures. The prevalence for paediatric trauma in talus fracture is estimated to be five times rarer than for adult trauma . The most common mechanism of injury in talus fractures is axial loading of the talus against the anterior tibia with the foot in dorsiflexion. The talar neck is the most common fracture site, followed by the talar body. REPORT: A 9-year-old boy was brought to emergency department following a fall from bicycle after his right foot caught in back wheel. He was unable to weightbear on his right foot and his anterior ankle region was swollen, with no open wounds or abrasions. Radiographs of right ankle revealed a fracture at neck of right talus (Hawkins type II ) then proceed with CT scan to characterize the fracture pattern and extent of injury. His fracture was fixed with two headless cannulated screws size 4.0 under I/I guidance. The patient was advised non-weight bearing with below knee cast for 6 weeks. After 2 months the patient was pain free and had resumed all his activities. X-ray after 1 year showed a consolidation of the fracture without evidence of avascular necrosis. The Hawkins classification can be used to describe the different types of fractures of the talar neck and to predict the risk of avascular necrosis. These injuries can be difficult to diagnose with plain radiograph, and further assessment with CT scan or MRI may be necessary. Undisplaced fracture can be managed non-operatively with cast immobilization and displaced fracture can be treated with either closed or open reduction. Complications are still likely to be encountered in the course of talus fractures treatment considering the precarious blood supply to the bone as well as complex ankle and subtalar articulations. According to Smith et al study with 29 subjects , displaced pediatric talus fractures and those associated with high-energy trauma resulted in more complications ; avascular necrosis (7%), arthrosis (17%),delayed union (3%),neuropraxia (7%) and the need for further surgery (10%). CONCLUSION: Talar fractures in the pediatric age group are very rare. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required. REFERENCES: 1. Vivek D , Jairam DJ , Paediatric Talus Fracture :Volume 5 Issue 8, International Journal of Science and Research August 2016 PG 1040-1041;
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spelling pubmed-72628312020-06-10 UNUSUAL TALUS FRACTURE IN CHILDREN Zulfahrizzat, S Nadzim, AS Norshaidi, S Abdul, Rauf A Orthop J Sports Med Article Talus fracture are extremely rare in children. The talus is predominantly made up of cartilage with higher elastic resistance than adult bone thus the pediatric talus bone can sustain higher forces before fractures. The prevalence for paediatric trauma in talus fracture is estimated to be five times rarer than for adult trauma . The most common mechanism of injury in talus fractures is axial loading of the talus against the anterior tibia with the foot in dorsiflexion. The talar neck is the most common fracture site, followed by the talar body. REPORT: A 9-year-old boy was brought to emergency department following a fall from bicycle after his right foot caught in back wheel. He was unable to weightbear on his right foot and his anterior ankle region was swollen, with no open wounds or abrasions. Radiographs of right ankle revealed a fracture at neck of right talus (Hawkins type II ) then proceed with CT scan to characterize the fracture pattern and extent of injury. His fracture was fixed with two headless cannulated screws size 4.0 under I/I guidance. The patient was advised non-weight bearing with below knee cast for 6 weeks. After 2 months the patient was pain free and had resumed all his activities. X-ray after 1 year showed a consolidation of the fracture without evidence of avascular necrosis. The Hawkins classification can be used to describe the different types of fractures of the talar neck and to predict the risk of avascular necrosis. These injuries can be difficult to diagnose with plain radiograph, and further assessment with CT scan or MRI may be necessary. Undisplaced fracture can be managed non-operatively with cast immobilization and displaced fracture can be treated with either closed or open reduction. Complications are still likely to be encountered in the course of talus fractures treatment considering the precarious blood supply to the bone as well as complex ankle and subtalar articulations. According to Smith et al study with 29 subjects , displaced pediatric talus fractures and those associated with high-energy trauma resulted in more complications ; avascular necrosis (7%), arthrosis (17%),delayed union (3%),neuropraxia (7%) and the need for further surgery (10%). CONCLUSION: Talar fractures in the pediatric age group are very rare. A minimal or undisplaced fracture of talus is less likely to undergo avascular necrosis than a displaced fracture but even with optimal treatment, avascular necrosis may still occur. It is of prime significance that these fractures should be diagnosed well in time to avert complications. Therefore an appropriate length of follow-up is required. REFERENCES: 1. Vivek D , Jairam DJ , Paediatric Talus Fracture :Volume 5 Issue 8, International Journal of Science and Research August 2016 PG 1040-1041; SAGE Publications 2020-05-29 /pmc/articles/PMC7262831/ http://dx.doi.org/10.1177/2325967120S00033 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Zulfahrizzat, S
Nadzim, AS
Norshaidi, S
Abdul, Rauf A
UNUSUAL TALUS FRACTURE IN CHILDREN
title UNUSUAL TALUS FRACTURE IN CHILDREN
title_full UNUSUAL TALUS FRACTURE IN CHILDREN
title_fullStr UNUSUAL TALUS FRACTURE IN CHILDREN
title_full_unstemmed UNUSUAL TALUS FRACTURE IN CHILDREN
title_short UNUSUAL TALUS FRACTURE IN CHILDREN
title_sort unusual talus fracture in children
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262831/
http://dx.doi.org/10.1177/2325967120S00033
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