PMC9744618_01
Injury films and CT scan demonstrated 180  inversion of proximal talus such that the dome was adjacent to the subtalar joint. The talus remained inverted after initial closed reduction attempt in the emergency department.
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fig1
The proximal talar body was subluxed posteromedially, but rotated 180  such that the talar dome was adjacent to the subtalar joint (Figure 1).
Intra-operative fluoroscopy demonstrates initial calcaneal pin traction, reduction through dual incision approach utilizing the bimalleolar fracture planes, mini fragment plate fixation of lateral talar neck and screw fixation of medial aspect, fixation of bimalleolar fracture, and final external fixator placement.
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fig2
Finally, the bimalleolar fracture was addressed appropriately, and an external fixator was applied to retain the alignment of the tibiotalar and subtalar joints (Figure 2).
7-week follow-up; radiographs demonstrated sclerosis of talar dome and body with mild lucency of lateral dome suggestive of potential Hawkins sign.
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At 7 weeks and 4 months postoperatively, radiographs revealed progressive sclerosis of the talar dome and body with possible lucency of the lateral dome (Figure 3).
1-year follow-up; radiographs demonstrated union of fractures, early subtalar and tibiotalar arthritis, and improvement of prior sclerosis of talus without signs of collapse of talar dome.
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At 1-year follow-up, radiographs demonstrated improvement of the sclerosis and no collapse of the talar dome (Figure 4).