Choudhary Laxman, Bains Amandeep, Aggarwal Aakarsh, Gahlot Nitesh, Chandel Akshant, Mechu Aryan
Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Orthop Case Rep. 2025 Sep;15(9):130-137. doi: 10.13107/jocr.2025.v15.i09.6042.
Pediatric talus fractures are rare and often challenging to diagnose, especially in skeletally immature patients. These injuries typically result from axial loading of the talus against the anterior tibia during dorsiflexion. Due to the unique biomechanical properties of immature bone, such fractures require significant force and are frequently associated with high-energy trauma. If missed or inadequately treated, complications, such as avascular necrosis, post-traumatic arthrosis, and delayed union may ensue.
We present the case of a skeletally immature girl who sustained bilateral talar neck fractures (Hawkins Type 1) following a high-energy mechanism of injury. The fractures were initially overlooked during the radiological assessment. However, persistent clinical concern prompted further evaluation, including repeat imaging, which revealed the injuries. The patient was subsequently managed with surgical fixation and close follow-up.
This case highlights the diagnostic difficulty of pediatric talus fractures, particularly bilateral injuries, which are exceedingly rare. It underscores the importance of correlating clinical findings with imaging and maintaining a high index of suspicion in pediatric trauma cases with appropriate mechanisms of injury.
小儿距骨骨折较为罕见，诊断往往具有挑战性，尤其是在骨骼未成熟的患者中。这些损伤通常是由于距骨在背屈时对胫骨前部的轴向负荷所致。由于未成熟骨骼独特的生物力学特性，此类骨折需要较大的外力，且常与高能量创伤相关。如果漏诊或治疗不当，可能会出现诸如缺血性坏死、创伤后关节炎和延迟愈合等并发症。
我们报告一例骨骼未成熟的女孩，在经历高能量损伤机制后发生双侧距骨颈骨折（霍金斯1型）。骨折在最初的放射学评估中被漏诊。然而，持续的临床疑虑促使进一步评估，包括重复影像学检查，从而发现了损伤。该患者随后接受了手术固定并密切随访。
本病例凸显了小儿距骨骨折，尤其是双侧损伤的诊断困难，此类损伤极为罕见。它强调了将临床发现与影像学结果相结合以及在具有适当损伤机制的小儿创伤病例中保持高度怀疑指数的重要性。
