Medial talonavicular-calcaneal fracture-dislocation in an adolescent: A challenging traumatic association (case...

Talus fractures in children are rare, with a prevalence of 0.008 % of all pediatric fractures. Subtalar dislocation accounts for 1 % of dislocations in trauma cases, making this combination extremely rare.

14-year-old patient suffered an isolated, uncomplicated closed injury to the right ankle from an accident. X-Ray showed an medial subtalar dislocation and a Hawkins stage III fracture of the talar neck. One hour post-trauma, reduction was performed under general anesthesia using Bootjack Technique, and the ankle was immobilized with a plaster cast. The reduction was confirmed by CT-scan. Given the satisfactory anatomical reduction and maintained articular congruence, orthopedic treatment approach was indicated. After 06 weeks of immobilization, physiotherapy sessions were initiated. The patient did not experience any functional impairment and resumed sports activities 03 months post-trauma.

According to the literature, closed subtalar fracture-dislocation, has not been previously described in the pediatric population. Diagnosing dislocation is straightforward, with treatment involving reduction through a boot jack maneuver. If a fracture is present, irreducibility should raise suspicion of interposition, requiring open reduction. While surgical treatment is often used, it increases the risk of ischemia. Orthopedic treatment remains a reliable and effective option, particularly in children, as it allows quicker management and avoids iatrogenic complications.

Subtalar fracture-dislocation in children is rare, and its management is not standardized. However, it is crucial to consider and identify this type of injury due to its rarity and significant risk of complications. Appropriate management is essential to accelerate treatment and avoid the risk of talar necrosis.