An Unusual Fracture of the Talus Associated with a Bimalleolar Ankle Fracture

A 53-year-old man sustained a fall from 1.25 m, injuring his hindfoot and ankle. Roentgenographic examination demonstrated a displaced vertical fracture through the neck of the talus with dislocation at the subtalar and tibiotalar joints (Hawkins Group III) and an ipsilateral bimalleolar fracture. Prompt anatomic reduction of the talus and bimalleolar fracture with rigid internal fixation was performed. Roentgenograms three years postinjury confirmed solid union of all fractures. Avascular necrosis of the talus had not occurred. Minimally disabling post-traumatic arthritis as both the ankle and subtalar joints was the only sequela. Only four similar injuries seem to have been reported previously in the literature. Despite the generally high incidence of avascular necrosis in Hawkins Group III talar neck fractures, none of these four cases developed this complication. A possible explanation is that with the presence of ipsilateral bimalleolar fracture, there is preservation of the extraosseous vascular supply that accompanies the deltoid and talofibular ligamentous complexes.