International Journal of Research in Orthopaedics | November-December 2018 | Vol 4 | Issue 6 Page 967 International Journal of Research in Orthopaedics Kumar V et al. Int J Res Orthop. 2018 Nov;4(6):967-970 http://www.ijoro.org Case Report Unusual case of talus neck fracture in a paediatric patient Vipan Kumar 1 , Anu Yarky 2 * INTRODUCTION Fractures of the talus are rare injuries with an estimated prevalence of 0.008% of all childhood fractures compared with 0.3% in adults. 1 As the paediatric foot is flexible and its skeletally immature bones are less brittle, they have higher elastic resistance than adult bone. Thus the talus of a child can sustain higher force before it fractures. The fracture of neck of talus is a more common fracture site than talar body. Immobilisation by applying cast is the treatment of choice for non-displaced fractures but surgery is needed for displaced fractures of the talus to lower the risk of complications such as avascular necrosis etc. CASE REPORT A 9 year old boy was brought to the emergency department with a history of fall from stairs of a height between 4 to 5 feet, while playing. On physical examination there was bruising over medial aspect of left ankle. Swelling was present over the left ankle but there was no evident deformity. He was unable to bear weight on his left foot. There was tenderness and crepitus on palpation and movements of the left ankle joint were painful and restricted. Peripheral pulses were palpable and there was no evident distal neurovascular deficit. Patient underwent x rays of left foot. Radiological findings were suggestive of fracture neck talus left foot as shown in figure (a). Below knee slab was applied and patient was prepared for surgery. Surgery: Patient underwent closed reduction and internal fixation with K wire. Post op ankle and foot radiographs showed fixation of fracture neck talus done with closed pinning using 3 K wires as shown in figures (b). Prognosis: A child's bones heal faster than an adult's because a thicker, stronger, and more active dense fibrous membrane (periosteum) covers the surface of their bones. ABSTRACT Talus fracture is a rare injury in a paediatric patient. Among talus fractures, the fracture of neck of talus is more common than fracture of body of talus. This can occur because of axial loading of the talus in a dorsiflexed foot against the anterior tibia. Children’s bones are skeletally immature and hence less brittle. They have higher elastic resistance than adult bone and are less likely to fracture. However talus fractures can still occur in paediatric patients when there is history of high-energy trauma. It needs surgery and can be associated with complications like avascular necrosis, delayed union, neuropraxia and may need a revision surgery. Here we present an unusual case of a talar neck fracture in a young boy, which was a closed fracture without distal neurovascular deficit. Closed reduction and internal fixation was done with K wire and post op X-rays and follow up X-rays showed complete union. Patient has normal joint mobility and strength after a period of 1 year follow up. Keywords: Paediatric talus neck fracture, Avascular necrosis, Closed reduction, Internal fixation 1 Department of Orthopaedics, 2 Department of Medicine, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India Received: 28 August 2018 Revised: 14 September 2018 Accepted: 15 September 2018 *Correspondence: Dr. Anu Yarky, E-mail: anu.yarky@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20183889