Paediatric talus fractures: A guide to management based on a review of the literature

•Talus fractures are rare injuries in children causing considerable complications such as avascular necrosis, non-union and post-traumatic arthritis in children.•The most common fracture pattern seen in children is hawkin's type 1 talar neck fractures, comprising 21.6% of all fractures.•AVN occurred in 5.7% for hawkin's 1, 11.8% for hawkin's 2, 53.5% for hawkin's 3 and 0 for hawkin's 4 fractures.•Worse outcomes are noted in adolescent patients with higher rates of non-union and need for arthrodesis despite no increase in fracture complexity. Talus fractures are devastating injuries in both adults and children. Well recognised complications such as avascular necrosis (AVN), post-traumatic arthritis and non-union contribute to patient morbidity. This systematic review aimed to assess the literature on these injuries in children and their associated incidence, classification, management and outcome. A systematic review of Embase and Medline databases was carried out in accordance with PRISMA guidelines. Inclusion criteria were clinically orientated studies looking at talus fractures in paediatric patients (less than 18 years old). Exclusion criteria were conference abstracts, opinion-based reports, articles not published in English and articles published prior to 1980. Data extracted included patient demographics, fracture classification, management and outcomes. 31 studies were included encompassing 143 patients and 167 fractures with a mean age of 11.9 years (1.2–18). The majority of fractures (43.7%, n = 73) were of the talar neck. 70.6% (n = 101) were managed operatively. The overall rate of AVN was 15.4% (n = 22), with a 96.5% union rate. Observed rates of AVN were 5.7% in Hawkin's 1, 11.8% in Hawkin's 2, 53.3% in Hawkin's 3 and 0 in Hawkin's 4 injuries. All cases of non-union occurred in children over 12 years, and seven children required arthrodesis (1x pantalar, 1x subtalar and 5x subtalar and tibiotalar) with a mean age of 14.4 years (9–17). Talus fractures are rare but potentially devastating injuries in children. This systematic review has shown comparable rates of AVN in children to their adult counterparts, with higher rates of non-union and arthrodesis in adolescent patients. A lower threshold for operative intervention to achieve anatomical reduction in these patients should be considered.