Fractures of the talus in the pediatric patient

Background: Talar fractures in children are extremely rare. Therefore available publications are only few, usually case reports or short-term follow-ups are available. However, considering the age and the long remaining lifespan of these patients, appropriate data and management guidelines are necessary. Methods: In this study we have examined the long-term outcome for 15 children (10 male, 5 female) with an average age of 10 (4-16) years, who had been treated at our department during a period of 21 years (1976-1997) following talar neck or body fracture. The test results were classified according to the AOFAS ankle-hind foot scale and our score for the feet [Thermann H, Hufner T, Roehler A, Tscherne H. Screw arthrodesis of the ankle joint. Technique and outcome. Orthopade 1996;25(2):166-76]. Results: Twelve patients (80%) were re-examined again after an average time of 11 (1-22) years. Altogether there were nine talar neck and three talar body fractures. Concomitant injuries were found in three cases. According to the Hawkins classification, three were type-1, seven were type-2 and one each were type-3 and 4. Two injuries were open and 13 closed. Seven children fell from a large height, six were involved in traffic accidents. Seven talar fractures were combined with other lesions of the foot or ankle. Five patients with Hawkins 1 fracture were treated conservatively. In the operative treatment in four cases k-wires were used, five were treated with screw fixation and in two patients external fixation was performed. In one case biodegradable pins were applied. In five cases combination of fixation devices were used. In three cases fragments were removed and in one case a cancellous bone graft was necessary. Three children had to undergo an arthrodesis of the ankle and subtalar joints (Hawkins 1.2 and 4). Wound infection occurred in two cases after open fractures. In AOFAS ankle-hind foot scale a middle result of 85 points was reached. In our valuation system, including results of conventional radiographs (8 patients), an averaged point value of 90 (reachable 100) was seen. Radiographs showed clear signs for arthrosis in two cases with Hawkins 1 and one patient with Hawkins 4 fracture. Avascular necrosis of the talus occurred after one Hawkins 3 injury. Conclusions: Talar fractures in the pediatric age group are very rare. They have shown terms of mechanism, treatment concepts and outcome pattern comparable to adults. As remodeling potential from further growth is poor, and avascular necrosis and osteoarthritis occur these fractures should be treated according to the standard therapy concepts.