1134 - Parcel fracture of the talus in children

Case Diagnosis: Parcel fractures of the talus in children are rare and usually result from violent trauma. The association with other foot and ankle injuries worsens the prognosis of these fractures, which must be managed early and appropriately.

Case Description: This was a 9-year-old child who had a fall from the stairs resulting in a closed right ankle injury. Examination found oedema over the anterior side of the tibio-talar joint and limited painful mobilisation of the ankle. X-ray and CT scan showed a patchy fracture of the articular surface of the talar trochlea. Treatment was surgical with open reduction and stabilisation with a mini screw driven under the cartilage.

At the last follow-up, the fracture was consolidated with correct ankle mobility without discomfort to walking.

Discussions: Parcel fractures of the talar dome are most often osteochondral fractures. They should be investigated on radiographs and if necessary by CT scanning or MRI. Depending on the size and displacement of the fragment, treatment may be orthopaedic or surgical. A small fragment can be removed arthroscopically. If it is larger, it can be fixed by screw fixation.

Conclusions: Although talus fractures in children are rare, they are prone to complications that can be disabling. Their therapeutic management has clearly benefited from the progress of imaging and in particular CT scanning. The reduction must be as anatomical as possible to guarantee a better result.