Talus with Trimalleolar Fracture: A Three-planar Injury of Ankle Joint Complex: A Unique Case Report

Malleolar fractures are common, often bimalleolar/trimalleolar. Talus fractures are rare, with risks like avascular necrosis (AVN). Unique challenges arise, especially in combined injuries, sometimes needing ankle arthrodesis.

An 18-year-old male laborer presented with a history of fall from height and sustained injury over the right ankle. Imaging showed a talar body fracture with a trimalleolar fracture on the same ankle. After the subsidence of swelling at 9 days, the patient underwent open reduction and internal fixation using screws and plates for malleolar fracture and Herbert screw for talus fracture. At 1-year follow-up, the patient had adequate range of motion of the ankle which was painless without any signs of AVN. The patient underwent ankle arthrodesis at 5 years old as he developed severe pain in the joint. After 1 year of arthrodesis, the patient has pain-free motion of the ankle joint.

Such fractures are rare with a unique mechanism of injury. There are chances of arthritis and instability owing to the variable cartilage damage and occult ligament injury. Stress radiographs after fracture union can help predict ankle instability. Internal fixation is the method of treatment in the acute setting, though the chances of late arthritis are high.