Decision to Preserving Ankle Joint Function in Neglected Neck Talus Fracture with Type 2 Diabetic Mellitus Patient : A Case Report

Abstract

Talus fractures are rare injuries to the hindfoot that still challenging in treatment. The anastomotic ring is likely to be damaged in neck talus fractures, which disrupt the blood flow and cause significant problems affecting fracture healing. Poor fracture healing and an increased risk of surgical complications were also associated with complex diabetes mellitus. We follow the progress of the illness from a 47 year old female complaint pain on her left ankle after falling down 6 months before outpatient. Physical examination shows swelling and varus deformed on affected ankle. Ankle x-ray and CT scan were done. Patient diagnosed as neglected close fracture left neck talus Hawkins type IV with type 2 diabetes mellitus. Then patient undergo an ankle arthroscopy to evaluate ankle joint and preserving ankle joint procedure by subtalar arthrodesis and iliac bone graft. This procedure achieved an excellent result in preserve ankle aligment, stability and soft tissue management. After 2 weeks wound heals without signs of infection and 3 weeks of followup VAS score mention from 0 to 1, with good compliance of the patient. Arthroscopy is safe procedure obtaining anatomical joint surface and reduce tissue damage. While arthrodesis enhance blood supply to encourage bone union, though loss of its ankle motion also has significant effect on ambulation.