An Uncommon Case of Bilateral Ankle and Foot Injury in a Pediatric Patient Leading to Bilateral Talus Fracture.

Introduction: Pediatric talus fractures are rare and often challenging to diagnose, especially in skeletally immature patients. These injuries typically result from axial loading of the talus against the anterior tibia during dorsiflexion. Due to the unique biomechanical properties of immature bone, such fractures require significant force and are frequently associated with high-energy trauma. If missed or inadequately treated, complications, such as avascular necrosis, post-traumatic arthrosis, and delayed union may ensue.

Case report: We present the case of a skeletally immature girl who sustained bilateral talar neck fractures (Hawkins Type 1) following a high-energy mechanism of injury. The fractures were initially overlooked during the radiological assessment. However, persistent clinical concern prompted further evaluation, including repeat imaging, which revealed the injuries. The patient was subsequently managed with surgical fixation and close follow-up.

Conclusion: This case highlights the diagnostic difficulty of pediatric talus fractures, particularly bilateral injuries, which are exceedingly rare. It underscores the importance of correlating clinical findings with imaging and maintaining a high index of suspicion in pediatric trauma cases with appropriate mechanisms of injury.