Full text of DOI:10.1016/S0020-1383(99)00227-2

Injury, Int. J. Care Injured 31 (2000) 63±65
www.elsevier.com/locate/injury
Case report
Avascular necrosis of the talus after a minimally displaced neck
of talus fracture in a 6 year old child
Imtiyaz S. Talkhani*, Declan Reidy, Esmond E. Fogarty, Frank E. Dowling, David
P. Moore
The Department of Paediatric Orthopaedics, Our Lady's Hospital For Sick Children, Crumlin, Dublin, Ireland
Accepted 4 August 1999
1. Case report:
A six year old boy was admitted after a heavy
object fell onto his right foot. The radiograph showed
a minimally displaced closed fracture of the neck of
the talus (Fig. 1). The fracture extended into the talo-
calcaneal joint. There was an associated undisplaced
distal tibial fracture (Fig. 2). A computed tomogra-
phy scan con®rmed the ®ndings (Fig. 3). There were
no other injuries. The foot was elevated initially and
managed in a below knee cast. Six weeks after injury,
radiographs showed increased density of the body of
the talus and a healed undisplaced distal tibial frac-
ture. The patient continued to have occasional dis-
comfort and pain in the ankle joint. Two years after
injury radiographic changes of avascular necrosis of
the body of the talus were obvious. There was con-
siderable irregularity with partial fragmentation of the
dome of the talus particularly in the medial side (Fig.
4). At this stage an isotope bone scan showed
increased activity at the dome of talus suggestive of
attempts at remodelling and repair. A magnetic res-
onance imaging scan con®rmed avascular necrosis of
the body of the talus with considerable involvement
of the dome of talus mainly involving the medial half
of the articular surface (Fig. 5).
* Corresponding author. Flat 12, Whinpark, Whinpark avenue,
Blackpool, FY3 8NZ, UK.
E-mail address: talkhani@aol.com (I.S. Talkhani).
Fig. 1. Antero-posterior view of the right ankle showing a minimally
displaced fracture of the neck of the talus.
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PII: S0020-1383(99)00227-2

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I.S. Talkhani et al. / Injury, Int. J. Care Injured 31 (2000) 63±65
face. Avascular necrosis in a minimally displaced or
undisplaced fracture has been reported in adults.
Avascular necrosis of the body of the talus has been
reported in children but only in association with frac-
ture-dislocations of the talus [1,4]. Jensen et al. [3]
reported an excellent long term prognosis of mini-
mally displaced and undisplaced fractures of the talus
in children.
A fracture of the neck of the talus is rare at the age
of six. The case reported here is unique. To our knowl-
edge there is no report of avascular necrosis occurring
as a complication of an undisplaced or minimally dis-
placed fracture of the neck of the talus in a child.
Four years after injury this child already has pain on
exercise. The long-term consequences of avascular
necrosis in this case are yet to be realised. This case il-
lustrates that a guarded prognosis should be given in
talar neck fractures even when the fracture is undis-
placed or minimally displaced and not associated with
dislocation.
Fig. 2. Lateral view of the right ankle showing a hairline spiral frac-
ture of the distal tibia.
This boy is able to lead an active life. He complains
of ankle pain intermittently and is unable to take part
in sports because of pain. He has developed a ¯exible
valgus deformity of the hindfoot. To date no surgical
intervention has been necessary.
2. Discussion
Thermann et al. [5] described a 13% incidence of
foot fractures, 50% of which were involving metatar-
sals and phalanges. The incidence of talus fractures
was found to be 0.008% of all childhood fractures
[5]. These are treated non-operatively and do not
usually cause problems in treatment. A long term fol-
low-up study Inokuchi et al. [2] of eighty-six fractures
of the talus revealed the poor outcome in talus frac-
tures to be due to late stage osteoarthrosis as a result
of avascular necrosis and incongruity of the joint sur-
Fig. 3. Computerised Tomography illustrating a minimally displaced
fracture of the neck of the talus.

I.S. Talkhani et al. / Injury, Int. J. Care Injured 31 (2000) 63±65
65
Fig. 5. Magnetic Resonance Scan illustrating avascular necrosis of
the medial dome of the talus.
Fig. 4. Antero-posterior view of the right ankle 4 years after injury
showing loss of the medial dome of the talus as a result of avascular
necrosis of the body.
References
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neck of the talus in a ten-year-old child: a case report and review
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