Decision on Preserving Ankle Joint Function in Neglected Neck Talus Fracture Hawkins Type IV

Abstract

Introduction: Talus fractures are rare injuries to the hindfoot that still challenging in treatment. Accounting for <1% of foot and ankle fractures, and approximately 50% of them occur at the level of the neck. The anastomotic ring of blood supply is likely to be damaged in neck talus fractures, which disrupt the blood flow and cause significant problems affecting fracture healing and its complication. Case Illustration: We follow the progress of the illness from a 47 years old female complain pain on her left ankle after falling down 6 months before outpatient. Patient diagnosed as neglected close fracture left neck talus Hawkins type IV. Then patient undergo an ankle arthroscopy to evaluate the ankle joint in decision to preserve the tibiotalar joint, while arthrodesis performed in subtalar and talonavicular joints in this patient. This procedure achieved a good result in preserve ankle alignment, stability and soft tissue damage reduction. Improvement of VAS and AOFAS Score from 5 and 39 preoperative to 0 and 81 in follow-up of 3 months after surgery with good compliance of the patient. Discussion: Arthroscopy is safe procedure obtaining anatomical joint surface and reduce tissue damage. Therefore, a clear articular surface must be found during arthroscopy in deciding to preserve the joint function. While subtalar arthrodesis also another option that can enhance blood supply to encourage union, although loss of some ankle motion has significant effect on ambulation.