Case report Double-talus sign? Joseph F. Baker *, Mihai H. Vioreanu, Hamid A. Khan Department of Orthopaedic Surgery, Cork University Hospital, Cork, Ireland 1. Introduction Talar body fractures are typically the result of high-energy trauma and carry significant morbidity. Typically they occur in young men and are predominantly closed injuries. Identification is essential early to reduce patient morbidity as avascular necrosis can ensue even despite timely operative intervention. 2 Plain X-rays are usually sufficient to diagnose the fracture whilst computed tomography (CT) can assist in aiding accurate classification, delineating the degree of comminution and opera- tive planning. 4 We describe the unique X-ray appearance of a talar body fracture that may assist in early diagnosis of sagittal shear type talar body fractures. 2. Case report A 23-year-old male presented to the Emergency Department with a right ankle injury. On arrival he was intoxicated but admitted to falling off the top of a dumpster and falling approximately 8 foot. The ankle was grossly swollen but with normal neurosensory examination. Plain X-rays of the ankle (Fig. 1) demonstrated the suggestive appearance of two tali on the anteroposterior projection. CT confirmed a split of the talar body in both sagittal and coronal planes (Fig. 2). The fracture was reduced anatomically and fixed with a headless compression screw and partially threaded cancellous screw (Fig. 3) on the day of admission via an anteromedial approach and medial malleolar osteotomy. 3. Discussion Plain radiographs form the basis of initial assessment in most orthopaedic trauma. An anteroposterior and lateral ankle X-ray in most cases are sufficient to diagnose the presence of a talar body fracture. With the tube tilted caudally 208 the talonavicular joint can be better visualized whilst the Broden view is useful to diagnose lateral process fractures and assess subtalar joint congruity. 1,3,6 In 1977, Sneppen et al. classified talar body fractures into six types depending on the fracture pattern. 5 The second of these, type Injury Extra 42 (2011) 201–202 A R T I C L E I N F O Article history: Accepted 22 August 2011 Fig. 1. AP and lateral X-rays of the ankle; note the appearance of a second talar dome on the AP projection. * Corresponding author. Tel.: +353 87 9452829. E-mail address: joseph.f.baker@gmail.com (J.F. Baker). Contents lists available at SciVerse ScienceDirect Injury Extra jou r nal h o mep age: w ww.els evier .co m/lo c ate/in ext 1572-3461/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2011.08.033