Talar fracture associated with cuboid fracture in a 9-year-old boy: case report

Abstract

Introduction: The talus has a unique anatomy and plays a fundamental role in the function of the ankle and foot. Talar fractures are considered an orthopedic emergency, especially displaced neck fractures, due to the high risk of avascular necrosis. However, these are rare in children with an estimated prevalence of 0.008% of all pediatric fractures. Talar neck fractures are associated with a high rate of complications, the most important of which include post-traumatic osteoarthritis and avascular necrosis. These are mainly related to the degree of initial displacement of the talar neck and the incidence can be 100%.
Objectives: The objectives of this work are to demonstrate the evolution of a patient with a rare pathology, with an injury association not reported so far and to carry out a bibliographic review of the topic.
Material and methods: A 9-year-old male patient with a talar neck fracture dislocation of the left foot associated with a cuboid fracture was retrospectively evaluated. Clinical, radiological and functional results  were evaluated after 3 years of evolution.
Results: In our case, open reduction and percutaneous fixation were performed. Excellent bone union was achieved without complications and with good ankle functionality after 3 years of followup. The AOFAS scale was performed, obtaining a score of 93/100. It did not present limitations in terms of pain, with a total of 40 points, it did not show limitations in terms of function, with a total of 45 points. We observed a slight valgus dexation of the hindfoot, asymptomatic, with a total of 8 points.
Conclusions: Talar fractures are rare in the pediatric population but can cause serious complications. In our case we observed a serious fracture, with an injury association not described until now, which presented a very good evolution, with bone consolidation, without complications and with good functional result 3 years after surgery.
As it is a very infrequent and rare pathology, the literature reviewed is generally of low scientific evidence and is based mostly on clinical case reports, except for a systematic review with a low number of patients.