Medical Student Sustains a Basketball-Related Talus Fracture

Abstract

Background Talar neck fractures are an uncommon injury, representing less than one percent of bony injuries of the foot (Shamrock & Byerly, 2022). They are associated with high-energy trauma, such as MVCs. Due to the risk of avascular necrosis, recognition and treatment are crucial (Matthews et al., 2022). Surgical treatment employs a dual anteromedial and anterolateral incision approach with open reduction and internal fixation (Lee et al., 2020). Post-traumatic arthritis or osteonecrosis can lead to fair to poor functional outcomes. Case Presentation A 23-year-old Asian-American male presented to an urgent care with a chief complaint of right ankle pain after landing awkwardly during a recreational basketball game. The patient had no significant past medical history or medications. Interestingly, he was a first-year medical student. On examination, the patient was unable to bear weight on his right foot with diffuse pain in his ankle and hindfoot. The right foot had intact skin with edema and ecchymosis to the lateral ankle with limited range of motion and was resting in a slightly plantarflexed and inverted position. Radiographs and CT scans demonstrated a fracture of the right talar neck, warranting a referral to orthopedics. Orthopedics confirmed a talar neck fracture with subtalar subluxation. A standard anteromedial and anterolateral approach was used for open reduction internal fixation. Two pilot holes were drilled into both the lateral and medial talar neck and pointed reduction clamps provided reduction. Two 3 mm headless compression screws were placed laterally, and two 4 mm headless compression screws were placed medially through the talar neck. Two 2.5 mm headless compression screws affixed a portion of displaced articular cartilage, achieving anatomic reduction. The patient was placed in a short leg splint and remained non-weight-bearing until seven weeks postoperative. One year postoperative, the patient ambulates with no limitations. Discussion This case demonstrates a low-energy mechanism of injury for a talus fracture. This patient presented similarly to an ankle sprain or fracture due to diffuse pain and mechanism of injury. Intolerance to weight-bearing, diffuse pain, and edema warranted radiographs and CT, leading to prompt diagnosis. Surgery sought to improve healing rates while allowing an early range of motion. Despite the high rate of poor outcomes following talar fractures, the patient had an excellent outcome with a full range of motion and normal gait. Sources: 1. Shamrock AG, Byerly DW. Talar Neck Fractures. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 2, 2022. 2. Matthews AH, Davis DD, Fish MJ, Stitson D. Avascular Necrosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 16, 2022. 3. Lee C, Brodke D, Perdue PW Jr, Patel T. Talus Fractures: Evaluation and Treatment. J Am Acad Orthop Surg. 2020;28(20):e878-e887. doi:10.5435/JAAOS-D-20-00116