Vemparala Rajesh Kumar, Rajan Giriprasad, Narayanan Sathyanarayanan
Department of Orthopaedics, Athani Hospitals, Palakkad, Kerala, India.
J Orthop Case Rep. 2023 Jul;13(7):99-103. doi: 10.13107/jocr.2023.v13.i07.3770.
Talus fractures are relatively rare injuries. These injuries are very serious because they can compromise the motion of foot and ankle and result in severe disability. Fractures of talar neck and body constitutes about 40% of all talus fractures. These occur secondary to high energy trauma most commonly motor vehicle collisions or fall from height. Fractures involving the lateral process results due to ankle inversion and dorsiflexion. Majority of talar surface is covered by articular cartilage and its role in force transmission between leg and foot makes successful treatment of such injuries a mandatory prerequisite to regain function. We present an atypical case of talus fracture in which fracture plane extends from posterior aspect of lateral talar process involving the body in coronal plane. Not much of literature has been published in this regard.
A 28 year old male presented with pain in the left ankle following fall from a tree. Following the radiological investigations, in coronal plane fracture line extends from posterior aspect of lateral talar process into the body medially and anteriorly. Internal fixation of the fracture was done by an open approach and a strict rehabilitation protocol was followed. At three months the patient had satisfactory healing of fracture without any irregularity of the articular surface and ambulant pain free with full range of ankle movements.
There are several choices to treat talar fractures. The ideal treatment should be customized as per the fracture morphology. Open reduction and internal fixation is one of the best options to restore the tibiotalar and subtalar joint congruency and to prevent post traumatic arthritis. Appropriate diagnosis and perioperative treatment is the key to success in talar fracture management.
距骨骨折相对少见。这些损伤非常严重，因为它们会影响足踝部的活动并导致严重残疾。距骨颈和体部骨折约占所有距骨骨折的40%。这些骨折多由高能量创伤继发引起，最常见的是机动车碰撞或高处坠落。涉及外侧突的骨折是由于踝关节内翻和背屈所致。距骨大部分表面被关节软骨覆盖，其在小腿和足部之间的力传递中起作用，这使得成功治疗此类损伤成为恢复功能的必要前提。我们报告一例非典型距骨骨折病例，其骨折平面从距骨外侧突的后部延伸，在冠状面累及距骨体部。关于这方面的文献报道不多。
一名28岁男性因从树上跌落致左踝疼痛就诊。经影像学检查，在冠状面骨折线从距骨外侧突的后部向内并向前延伸至距骨体部。通过开放手术对骨折进行了内固定，并遵循了严格的康复方案。三个月时，患者骨折愈合良好，关节面无任何不平整，可无痛行走，踝关节活动范围正常。
治疗距骨骨折有多种选择。理想的治疗应根据骨折形态进行定制。切开复位内固定是恢复胫距关节和距下关节一致性以及预防创伤后关节炎的最佳选择之一。正确的诊断和围手术期治疗是距骨骨折治疗成功的关键。
