Fracture of the astragalus in pediatric patients, an unusual entity

• Published in: International journal of surgery case reports 2021-04, Vol.81, p.105648, Article 105648
• Main Authors: Jasqui Remba, Salomón, Baley Amiga, Isaac, Aragon, Lourdes Noemi-Santos, Montalvo, Mauricio, Portman Santos, Daniel
• Format: Article
• Language: English
• Subjects: Astragalus fracture; Avascular necrosis; Case Report; Foot pain; Pediatric
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.105648

•The poor blood supply of the astragalus increases the risk of avascular necrosis.•The astragalus is composed mainly of cartilage, which reduces the risk of fracture.•It is important to keep this fracture in mind in injuries that could compromise the astragalus.•The physician needs to know the differential diagnoses to get the right diagnosis nd to administer the correct treatment. The fracture of the astragalus is an unusual bone fracture (Ladero and Concejero, 2004) and is even more unusual in pediatric patients. The astragalus is a bone surrounded by cartilage and other structures making it difficult to appreciate on an X-ray which can lead to misdiagnosis (Ladero and Concejero, 2004; Inal and Inal, 2014) and could lead to not applying the right treatment and risk avascular necrosis or other sequelae. 3-year-old male with foot pain and edema+++, unable to walk or stand up since a fall 2 days before, had a doubtful diagnosis after an x-ray showed no apparent bone injury. A CT scan confirmed astragulus fracture; it was then treated adequately, thus avoiding complications that could have occurred had the fracture not been diagnosed and treated correctly. The limb was immobilized with a suropodalic cast for 5 weeks. No surgery was performed because of the patient's age and because the fracture was not displaced (Hawkins type 1) (Jasqui-Remba and Rodriguez-Corlay, 2016; Urrutia et al., 1999). There is a risk of misdiagnosis in these cases since the astragulus fracture might not show up in an X-ray, as in the case presented. A CT scan can detect the fracture and thus help consolidate the bone correctly. The correct differential diagnosis also reduces the risk of avascular necrosis, which increases due to poor blood supply to the astragalus.