SLR - May 2011 - Mario Voloshin
Reference: Jeremy T. Smith, MD, Tracy A. Curis, MA, Samantha Spencer, MD, James R Kasser, MD, Susan T. Mahan, MD, MPH. (2010). Complications of Talus Fractures in Children. Journal of Pediatric Orthopaedics, 30(8):779-784.
Scientific Literature Review
Reviewed by: Mario Voloshin, DPM
Residency Program: New York Hospital of Queens
Podiatric relevance:
Podiatric surgery has evolved to include treatment of talus fractures in children, which are rare, with a reported incidence between 0.01% and 0.08%. There are only a limited number of case studies published in literature about talus fractures, most of which report on adults. The largest of these studies includes 25 fractures. Since children participate in high-impact sports more often than adults do, and talus fractures often follow with great disability, it is crucial to understand the outcomes and complications of talus fractures in children.
Methods:
Clinical records and radiographs of 29 children, mean age 13.5 years (range 1.2-17.8), over a 9 year period, were reviewed to determine mechanism of injury, fracture type, associated injury and treatment. Post-traumatic complications assessment was limited to avascular necrosis, arthrosis, nonunion or delayed union, neurapraxia, infection or wound healing issues, and/or need for further surgery. Mean follow-up was 24 months (range 6 months–5 years).
Results:
12 fractures (36%) were the result of a high-energy mechanism, while a low-energy mechanism resulted in 21 fractures (64%). None of the patients sustained an open fracture. Avascular necrosis occurred in 2 patients (7%), both with displaced talar neck fractures. Arthrosis developed in 5 patients (17%), delayed union in 1 (3%), neurapraxia in 2 (7%), infection in 0. 3 patients (10%) required further surgery. A high-energy mechanism and fracture displacement were associated with a greater number of complications. Older children were also shown to demonstrate a higher incidence and greater severity of talus fractures.
Conclusions:
This article reviewed 29 cases of talus fractures in children over a nine-year period, and categorized the various complication rates. While previous studies reported a higher rate of avascular necrosis of the talus, only 2 patients in this series developed this complication. The authors point out that their low incidence of avascular necrosis may be due to the small number of displaced talus fractures, but they also suggest that the pediatric talus may be less likely to displace when fractured. Thicker periosteum and abundant malleable cartilage may inherently protect against displacement. Although pediatric talus fractures are very rare injuries, and this study’s incidence of avascular necrosis and arthrosis was less than reported in other studies, a high index of suspicion for these complications should be maintained.
Level IV retrospective case series