Zhang Sitong, Li Dejian, Wang Qian
Department of Orthopedics, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China.
Front Surg. 2025 Mar 25;12:1490126. doi: 10.3389/fsurg.2025.1490126. eCollection 2025.
Talar fractures represent less than 1% of all fractures, and combined fractures involving the posteromedial and posterolateral talar processes along with a lateral process fracture are exceptionally rare. These fractures are considered severe injuries that may lead to prolonged disability and persistent pain. The intricate anatomical configuration and the proximity of nerves and blood vessels surrounding the talus present substantial challenges in the management of posterior talar process fractures. Surgical procedures in this area are rare, and inadequate treatment may lead to significant discomfort and limitations in daily functioning for patients. In this case report, we describe a 45-year-old male who experienced a fall from a 2-meter height, leading to persistent right ankle swelling for 6 days. Radiographs, CT scans, and 3D-CT reconstructions identified fractures involving the posteromedial and posterolateral talar processes, as well as an avulsion fracture at the calcaneofibular ligament attachment site. To the best of our knowledge, there are no previously documented reports of this combined injury. We conducted arthroscopically assisted reduction and internal fixation through a posterior approach utilizing Herbert screw. The patient underwent a 4-year postoperative follow-up, during which favorable fracture healing was observed. The objective of this report is to demonstrate that arthroscopy offers a well-defined surgical field, aids in reduction and internal fixation, and to suggest a novel treatment approach for this uncommon fracture pattern.
距骨骨折占所有骨折的比例不到1%，累及距骨后内侧和后外侧突以及外侧突骨折的复合型骨折极为罕见。这些骨折被视为严重损伤，可能导致长期残疾和持续疼痛。距骨复杂的解剖结构以及其周围神经和血管的毗邻关系给距骨后突骨折的治疗带来了巨大挑战。该区域的外科手术很少见，治疗不当可能会给患者带来明显不适，并限制其日常功能。在本病例报告中，我们描述了一名45岁男性，他从2米高处坠落，导致右踝持续肿胀6天。X线片、CT扫描和三维CT重建显示骨折累及距骨后内侧和后外侧突，以及跟腓韧带附着部位的撕脱骨折。据我们所知，此前尚无关于这种复合型损伤的文献报道。我们通过后方入路利用Herbert螺钉进行关节镜辅助复位和内固定。患者术后接受了4年随访，在此期间观察到骨折愈合良好。本报告的目的是证明关节镜提供了清晰的手术视野，有助于复位和内固定，并为这种罕见的骨折类型提出一种新的治疗方法。
