Rationale: A comminuted fracture of the medial malleolus combined with a talar neck fracture is a uncommon finding. Surgeons are often unaware of its unique injury mechanism, which complicates fracture reduction and fixation and may cause potential complications during and after surgery. This report presents a case of a talar neck fracture combined with a comminuted medial malleolar fracture and analyzes its injury mechanism.
Patient concerns: A 35-year-old Chinese man sustained a talar neck fracture and comminuted medial malleolus in an electric bicycle accident, accompanied by inability to bear weight.
Diagnoses: Radiographs and computed tomography confirmed a displaced talar neck fracture with intra-articular extension and a comminuted medial malleolar fracture. magnetic resonance imaging additionally revealed deltoid ligament rupture and tibialis posterior tendon exposure.
Interventions: After 5 days of skin swelling resolution, he underwent open reduction and internal fixation using compression screws, Kirschner wires, and transosseous tunnel sutures.
Outcomes: At the 10-month follow-up, radiographs showed satisfactory bone healing without avascular necrosis. Functional outcome improved significantly, with the American orthopaedic foot & ankle society ankle-hindfoot score rising from 20 preoperatively to 85 at final assessment.
Lessons: This case supports pronation-dorsiflexion as the likely injury mechanism. Recognition of concomitant ligament and tendon injuries is critical. Combined screw fixation and transosseous tunnel sutures can achieve stable fixation, preserve ankle joint function, and reduce the risk of complications.
Keywords: AOFAS ankle-hindfoot scale; ORIF; medial malleolar fracture; open reduction internal fixation; talar neck fracture; transosseous tunnel sutures technique.
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