Monestier L, Riva G, Faoro L, Surace MF. Rare shear-type fracture of the talar head in a thirteen-year-old child — Is this a transitional fracture: A case report and review of the literature. World J Orthop 2021; 12(5): 329-337 [PMID: 34055590 DOI: 10.5312/wjo.v12.i5.329]
Corresponding Author of This Article
Luca Monestier, MD, Doctor, Surgeon, Orthopedic and Trauma Unit, ASST Sette Laghi, via L. Borri 57, Varese 21100, Italy. dottlucamonestier@outlook.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2021; 12(5): 329-337 Published online May 18, 2021. doi: 10.5312/wjo.v12.i5.329
Rare shear-type fracture of the talar head in a thirteen-year-old child — Is this a transitional fracture: A case report and review of the literature
Luca Monestier, Giacomo Riva, Luca Faoro, Michele Francesco Surace
Luca Monestier, Giacomo Riva, Orthopedic and Trauma Unit, ASST Sette Laghi, Varese 21100, Italy
Luca Faoro, Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
Michele Francesco Surace, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21020, Italy
Author contributions: Monestier L and Faoro L were the patient’s surgeons; Monestier L, Riva G, Faoro L reviewed the literature and contributed to manuscript drafting; Monestier L analyzed the imaging findings; Surace MF, Monestier L and Riva G were responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: The informed consent statement has been correctly acquired. The file was previously sent to the reviewer.
Conflict-of-interest statement: Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
CARE Checklist (2016) statement: The CARE checklist (2016) statement has been correctly completed. The file was previously sent to the reviewer.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Monestier, MD, Doctor, Surgeon, Orthopedic and Trauma Unit, ASST Sette Laghi, via L. Borri 57, Varese 21100, Italy. dottlucamonestier@outlook.it
Received: January 12, 2021 Peer-review started: January 12, 2021 First decision: January 24, 2021 Revised: January 29, 2021 Accepted: March 18, 2021 Article in press: March 18, 2021 Published online: May 18, 2021
Abstract
BACKGROUND
Talar fractures are exceedingly rare in childhood. There are very few studies on the clinical aspects, the long-term outcomes and the appropriate treatment of these fractures in pediatric patients. The mechanism of trauma consists of the application of a sudden dorsiflexion force on a fully plantar-flexed foot. Traumatic mechanism, symptoms and imaging of injuries of the talar head are similar to transitional fractures that are normally described at the distal epiphysis of the tibia: the so-called transitional fracture is defined as an epiphyseal injury when the growth plate has already started to close.
CASE SUMMARY
A thirteen-year-old girl reported a high-energy trauma to her right foot, due to falling from her horse. X-rays at the Emergency Department were negative. Because of persistent pain, the patient was assessed by an orthopedic surgeon after two weeks and computed tomography scans revealed a misdiagnosed displaced shear-type fracture of the talar head. Hence, surgical open reduction and fixation with two headless screws was performed. The girl was assessed regularly, and plain films at follow-up revealed complete healing of the fracture. Within six months after surgery, the patient returned to pre-injury sport activities reporting no complications.
CONCLUSION
Injuries of the talar head in childhood should be considered as transitional fractures. Open reduction with internal fixation aims to reduce malalignment and osteoarthritis. Computed tomography scans are recommended in these cases.
Core Tip: Fractures of the talar head in childhood must be judged as transitional fractures. These injuries, typically occurring at the distal tibia, are defined as an epiphyseal injury when the growth plate has already started to close. This crucial aspect should be considered by orthopedic surgeons: surgical treatment is preferred in order to reduce malalignment and osteoarthritis.
