Published online May 18, 2021. doi: 10.5312/wjo.v12.i5.329
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
Processing time: 119 Days and 18.2 Hours
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.
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.
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.