Fractures of the talus--differences between children and adolescents

Fractures of the talus represent serious injuries of the foot skeleton. The most significant complications include osteonecrosis and posttraumatic malalignment with subsequent arthritis. The aim of our study was to compare treatment and outcome of fractures of the talus between children and adolescents.

From 1990 to 2005, 24 patients (18 male, 6 female) presented with 25 fractures of the talus. The medical records were reviewed retrospectively. Follow-up was performed by radiographical grading, and the functional outcome was measured using the Foot-Function-Index.

Nine patients were 12 years of age or younger, and 15 patients presenting 16 talar fractures were older than 12 years. Although most fractures of the talus in children younger than 12 years were classified as Marti-Weber type I and II fractures, more than two thirds of the fractures in patients older than 12 years were Marti-Weber type III and IV fractures. Two thirds of the patients younger than 12 years were treated nonoperatively, whereas nonoperative treatment was possible in only three talar fractures in adolescents. No necrosis at follow-up (mean period, 3.2 years; range, 7 months to 8.4 years after end of treatment) was detected in children (<12a), whereas five patients older than 12 years developed persisting necrosis.

Even though there is no apparent difference in the cause of the trauma leading to fractures of the talus, adolescents present with more severe fractures of the talus compared with children younger than 12 years. In addition, we did not observe persistent osteonecrosis in patients younger than 12 years old, and the outcome is favorable in most cases irrespective of the mode of treatment.