RESUMO
Background: Talus fractures are extremely uncommon, accounting for approximately 1 % of foot and ankle fractures. The talar neck fracture has a high probability of damaging the anastomotic ring, which would interrupt blood circulation to talar body and cause serious issues with fracture healing and integrity. Due to insufficient radiological and clinical examination, approximately 39 % of midfoot and ankle fractures could be undiagnosed after initial evaluation. Talus fractures account for about half of these missed fractures. Anatomic reduction and advanced fixation methods can be performed in the management of neglected talus neck fracture for the purpose of improving functional outcome. Case report: A 30-year-old male patient presented with swelling and pain on the right foot while walking for three months. He had previously fallen about two meters from stairs three months back. Instead of going to the hospital, he received conventional massage therapy. Three months later, he came to us complaining of chronic, dull aching, swelling, and continuous pain when walking and standing. After radiology evaluation, the patient was diagnosed with neglected nonunion type III Hawkins fracture of the neck talus and managed by double incision approach, Iliac crest cancellous bone graft, open reduction and internal fixation (ORIF) with cannulated screw. He was able to return to full weight bearing and his previous activity without experiencing any pain after 14 months. Conclusion: Open reduction and internal fixation (ORIF) with Iliac crest cancellous bone graft is a reliable methods for neglected non-union type III Hawkins fracture of neck talus with great functional outcomes after 14 months of follow up.
RESUMO
INTRODUCTION: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6-8). A high level of clinical suspicion is required to avoid missing such injuries. CASE REPORT: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. CONCLUSION: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity.