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Bilateral talus fracture dislocation: is avascular necrosis inevitable?
Gopisankar Balaji G1, Justin Arockiaraj2
1Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
BMJ Case Reports
|August 27, 2014
Summary
A rare case of bilateral talar fracture dislocation occurred after a heavy stone injury. Despite treatment, the patient developed avascular necrosis in both ankles, with one collapsing completely.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Radiology
Background:
- Bilateral simultaneous fracture dislocation of the talus is an exceptionally rare injury, typically resulting from high-energy trauma.
- This case highlights a unique presentation in a 45-year-old male following significant blunt force impact.
Observation:
- The patient sustained an open talus dislocation with a lateral process fracture on the right and a closed talar neck fracture dislocation on the left.
- Initial management involved debridement and external fixation for the right ankle, and open reduction internal fixation for the left.
Findings:
- At 34-month follow-up, the patient could walk 2 km pain-free, but exhibited bilateral restricted ankle range of motion.
- Radiographic evidence showed bilateral avascular necrosis of the talus, with complete collapse on the right side.
Implications:
- This case underscores the severe complications, including avascular necrosis, that can arise from bilateral talar fracture dislocations.
- Sequential radiographs are crucial for monitoring the progression of avascular necrosis and bony collapse in such rare injuries.
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