title: A pediatric comminuted talar fracture treated by minimal K-wire fixation without using a tourniquet.
abstract: BACKGROUND
  Pediatric comminuted talar fractures are reported to be rare, and treatment options such as minimal internal K-wire fixation without using a tourniquet to prevent avascular necrosis have not previously been investigated.
  
  
  METHODS
  We report a case of a comminuted talar body and a non-displaced neck fracture with dislocation of the tibiotalar, talonavicular and subtalar joints with bimalleolar epiphyseal fractures in an 11-year-old boy due to a fall from height. We present radiological findings, the surgical procedure and clinical outcomes of minimal internal K-wire fixation without using a tourniquet.
  
  
  METHODS
  Avascular necrosis rates are reported to be between 0 % and 66 % after fractures of the neck of the talus and the talar body in children. The likelihood of developing avascular necrosis increases with the severity of the fracture.
  
  
  CONCLUSIONS
  To avoid avascular necrosis in a comminuted talar fracture accompanied by tibiotalar, talonavicular, subtalar dislocations and bimalleolar epiphyseal fractures, a minimal internal K-wire fixation without the use of a tourniquet was performed. The outcome was evaluated by the American Orthopedic Foot and Ankle Society score (AOFAS). A score of 90 (excellent) was found at the end of the second year of follow up. Radiology revealed preservation of the joint with no evidence of avascular necrosis, and clinical findings revealed a favorable functional outcome after two years.
  
  
  METHODS
  4.
authors.affiliation: Assistant Professor, M.D., Dumlupinar University, School of Medicine, Department of Orthopedics and Traumatology, Kutahya, Turkey. E-mail: sermetinal@yahoo.com.tr.
authors.forename: Sermet
authors.initials: S
authors.lastname: Inal
authors.affiliation: Specialist, M.D., Dumlupinar University, Kutahya Evliya Celebi Education and Research Hospital, Department of Anesthesiology and Reanimation, Kutahya, Turkey. E-mail: kalinis19@hotmail.com.
authors.forename: Canan
authors.initials: C
authors.lastname: Inal
mesh_terms: D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001864:Bone Wires; D002648:Child; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014111:Tourniquets; D016896:Treatment Outcome
keywords: avascular; fracture healing; necrosis; talus; tourniquets