Abstract
Objective
The objectives of this present case study are to report a rare combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in a 5-year-old child and to describe its radiological features, surgical treatment and clinical outcome.
Case summary
A 5-year-old male boy was injured in a car accident in which his left foot underwent one of the tires. On arrival at the hospital, a displaced talar neck fracture associated both with a cuboid fracture and compression of the articular surface of the cuboid at the calcaneocuboid join was identified. Fractures were fixed surgically. Leg was protected with a below-knee plaster split immobilization and non-weight-bearing for 5 weeks. After that period, the patient initiated a rehabilitation protocol with active and passive motion exercises.
Discussion
Fractures and fracture dislocations at the mid-tarsal joint have an important impact on the global foot function because malunion can result in post-traumatic arthritis and three-dimensional deformities of the foot. If a cuboid compression fracture is not reduced properly, it can result in the shortening of the lateral column with the development of an abduction, pronation and flat foot deformity. A talar neck fracture, if unreduced, can result in medial column displacement and rotational dislocation of the talar head, leading to a subluxation in the talonavicular joint with severe restriction of foot function. With early surgical treatment and open reduction and internal fixation, our patient recovered from the accident without having symptoms of pain, avascular necrosis, postoperative foot deformities or neurovascular deficits.
Conclusions
The combination of a displaced talar neck fracture with a compression fracture of the calcaneocuboid joint in children usually requires correct diagnoses and early treatment with anatomic reduction and internal fixation to prevent severe post-traumatic deformities.
Level of evidence
V.
References
Mayr J, Peicha G et al (2006) Fractures and dislocations of the foot in children. Clin Podiatr Med Surg 23:167–189
Eberl R, Singer G, Schalamon J, Hausbrandt P, Höllwarth ME (2010) Fractures of the talus—differences between children and adolescents. J Trauma 68(1):126–130
Rammelt S, Zwipp H, Gavlik JM (2000) Avascular necrosis after minimally-displaced talus fracture in a child. Foot Ankle Int 21:1030–1036
Jensen I, Wester JU, Rasmussen F, Lindequist S, Schantz K (1994) Prognosis of fracture of the talus in children. 21 (7–34)-year follow-up of 14 cases. Acta Orthop Scand 65:398–400
Smith JT, Curtis TA, Spencer S, Kasser JR, Mahan ST (2010) Complications of talus fractures in children. J Pediatr Orthop 30(8):779–784
Mazel C, Rigault P, Padovani JP, Finidori G, Touzet P (1986) Fractures of the talus in children. Apropos of 23 cases [French]. Rev Chir Orthop Reparatrice Appar Mot 72(3):183–195
Schwarz N, Gebauer M (1983) Fractures of the talus in children (German). Unfallheilkunde 86:212–221
Zwipp H, Ranft T (1991) Malunited juvenile fractures in the foot region (German). Orthopäde 20(6):374–380
Blumberg K, Patterson RJ (1991) The toddler’s cuboid fracture. Radiology 179(1):93–94
Simonian PT, Vahey JW, Rosenbaum DM, Mosca VS, Staheli LT (1995) Fracture of the cuboid in children. A source of leg symptoms. J Bone Jt Surg Br 77(1):104–106
Senaran H, Mason D, De Pellegrin M (2006) Cuboid fractures in preschool children. J Pediatr Orthop 26(6):741–744
Kurz W, Gündel T, Hardtmann H (1984) Tarsal fractures in childhood (German). Zbl Chir 109:984–990
Hermel MB, Gershon-Cohen J (1953) Nutcracker fractures of the cuboid by indirect violence. Radiology 60:850–854
Wiley JJ (1981) Tarso-metatarsal joint injuries in children. J Pediatr Orthop 1:255–260
Holbein O, Bauer G et al (1998) Fracture of the cuboid in children: case report and review of the literature. J Pediatr Orthop 18(4):466–468
Hsu JC, Chang JH et al (2004) The nutcracker fracture of the cuboid in children: a case report. Foot Ankle Int 25(6):423–425
Ceroni D, De Rosa V et al (2007) Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature. J Pediatr Orthop 27(5):557–561
Ruffing T, Muhm M, Winkler H (2010) Nutcracker fracture of the cuboid in children (German). Unfallchirurg 113:495–500
Meier R, Krettek C, Griensven M, Chawda M, Thermann H (2005) Fractures of the talus in the pediatric patient. J Foot Ankle Surg 11:5–10
Schulze W, Richter J et al (2002) Surgical treatment of talus fractures: a retrospective study of 80 cases followed for 1–15 years. Acta Orthop Scand 73(3):344–351
Zwipp H (1994) Chirurgie des Fusses. Springer, Wien
Prasad KS (2004) Avascular necrosis of the talus after a minimally displaced neck of talus fracture in a 6-year-old child [Injury 31 (2000) 63–65] Is it really unique? Injury 35:1216–1217
Rammelt S, Grass R, Zwipp H (2004) Nutcracker fractures of the navicular and cuboid. Ther Umsch 61(7):451–457
Main BJ, Jowett RL (1975) Injuries of the midtarsal joint. J Bone Jt Surg [Br] 57(1):89–97
Rammelt S, Zwipp H, Schneiders W, Heineck J (2010) Anatomical reconstruction after malunited Chopart joint injuries. Eur J Trauma Emerg Med 36:196–205
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Godoy-Santos, A.L., Albuquerque, D.M., Diniz-Fernandes, T. et al. Fracture of the talar neck associated with a compression fracture of the calcaneocuboid joint in a 5-year-old child: a case report. Arch Orthop Trauma Surg 133, 1267–1271 (2013). https://doi.org/10.1007/s00402-013-1791-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-013-1791-9