Fractures of the lateral process of the talus

This study is a retrospective review of nine patients who sustained isolated fractures of the lateral process of the talus. The majority were caused by inversion or a combination of inversion and dorsiflexion of the foot. Following a review of the literature and anatomical dissections the authors recommend a classification based on anterior-posterior tomography of the talus, into intra- and extra-articular fractures.     

Fractures of the lateral process of the talus

A retrospective review of nine patients with fractures of the lateral process of the talus indicates that a substantial portion of patients will have persistent symptoms if the fracture is not diagnosed and appropriately treated soon after the injury. When a patient is evaluated for the symptoms of a "sprained ankle," these fractures are often overlooked on the initial roentgenograms. If untreated, these fractures often fail to heal, and persistent pain over the lateral aspect of the ankle following an inversion injury should be investigated for the possibility of this diagnosis. Prompt treatment of acute fractures appears to lead to the best result. Nondisplaced fractures heal well in a short-leg cast, with six weeks of immobilization. Large displaced fracture fragments require surgical treatment: single large fragments should be reduced and internally fixed, and large comminuted fragments should be excised.     

Fractures of the lateral process of the talus

Thirteen patients with isolated fractures of the lateral process of the talus were reviewed. Two fracture types were seen: an intra-articular type in seven cases and an avulsion type in six cases. The former occurs at the base of the process as a result of blows to the calcaneus. The latter occurs at the tip as a result of traction by ligaments. Open reduction and internal fixation were performed in four cases of displaced intraarticular-type fracture and in one case of unstable avulsion type fracture. Bone union was complete, and the results were good in every case. However, pain on walking persisted in two cases treated conservatively. It was suspected that many isolated fractures of the lateral process of the talus are misdiagnosed as severe sprain and cause persistent ankle pain. Thus, accurate diagnosis and appropriate treatment in the early stages are essential to prevent persistent symptoms.     

Fractures of the lateral process of the talus

In approximately 1% of all ankle sprains a fracture of the lateral process of the talus can be found. This fracture is probably even more common than this suggests, as it is often missed. We recommend that CT examination be performed in the investigation of ankle sprains when swelling, hematoma, and pain are present, when there is no instability of the ankle ligaments, and when no conclusive findings are yielded by conventional X-ray. Various theories on the best therapy have been propounded in the literature. Our retrospective study involved six patients. In two cases the fracture was treated by surgical operation. The remaining four patients received conservative therapy. Both patients who were operated upon had dislocated fractures sustained shortly before. On follow-up they were found to be completely symptom free. One further patient, who underwent conservative treatment for a fresh undislocated fracture, was also found to be free of all symptoms at follow-up. The late radiological findings in these three patients were incontestable. The three remaining patients, whether they had undergone conservative our functional treatment, reported considerable problems at follow-up, i.e. starting pain and a decreased range of motion in the talo-calcanear joint.     

Associated lateral process and posteromedial tubercle talus fractures:a case report and literature review

This article describes the case of a 39-year-old man who sustained both a lateral process and posteromedial tubercle talus fracture. Both fractures were treated with open reduction and internal fixation resulting in a satisfactory clinical outcome. Although this combination of injuries has been described in the literature, this is the first reported case to describe surgical fixation of both fractures.     

Fractures of the lateral process of the talus in children

Fractures of the lateral process of the talus are an uncommon injury, which are often misdiagnosed as severe ankle sprain. This error may result in inappropriate treatment of an intraarticular fracture, with subsequent posttraumatic arthrosis. To date, only one fracture of a lateral talar process has been reported in a child, in whom delayed diagnosis and initial mismanagement led to a suboptimal result. The sport of 'snowboarding', which is gaining in popularity, has been significantly associated with fractures of the lateral talar process, leading some authors to dub this fracture 'Snowboarder's Fracture'. This and the ever-increasing incidence of major trauma lead us to believe that this fracture will be encountered more frequently, even in the pediatric population, as the two factors mentioned do not pass over this group. We report lateral talar process fractures in two children: one in a 9-year-old girl and one in an 11-year-old boy, the latter associated with talar neck and body fractures. Timely diagnosis enabled prompt open reduction and internal fixation, preventing subtalar arthrosis. We discuss the pertinent anatomy and mechanism, and present the clinical picture, imaging studies and treatment. Two important points are exemplified by these cases. First, this fracture, although rare, does occur in children, and should be sought in appropriate settings. Second, despite the severe talar injury in the 11 year old, early diagnosis and intervention conserved foot function.     

Fracture of the lateral process of the talus in snowboarders

We investigated the clinical and radiological outcome after unilateral fracture of the lateral process of the talus in 23 snowboarders with a mean follow-up of 3.5 years (12 to 76 months). In this consecutive cohort study both operative and non-operative cases were considered. The mean American Orthopaedic Foot and Ankle Society hindfoot score was 94 (82 to 100). The non-operative group of seven with a minimally-displaced fracture scored higher (98 points) than the operative group of 16 with displaced or unstable fractures (93 points). In 88% of operative cases, significant concomitant hindfoot injuries were found at operation. All but eight (35%) patients (six operative and two non-operative) regained their pre-injury level of sporting activity. Subtalar osteoarthritis was present in nine (45%) of the 20 patients available for radiological review, including one late-diagnosed non-operative case and eight operative cases with associated injuries or fracture comminution. The outcome after fracture of the lateral process of the talus in snowboarders is favourable provided an early diagnosis is made and adequate treatment, which is related to the degree of displacement and associated injuries, is undertaken.     

Associated lateral process and posteromedial tubercle talus fractures with entrapment of the medial neurovascular bundle: A case report

This paper describes a case of an isolated fracture of the lateral process of the talus associated with a fracture in the posteromedial tubercle of the talus with entrapment of the medial neurovascular bundle. Currently no similar cases have been published describing this type of neurovascular bundle injury. Furthermore, in contrast to previously published cases, both fractures were treated surgically despite the absence of posteromedial tubercle fracture displacement. This article reviews the literature and provides useful recommendations for the clinical management of similar cases in the future.     

Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years

BackgroundWe retrospectively evaluated the mid-term results of surgery for talar process fractures (lateral and posterior processes) and exploratively analyzed parameters that potentially impact treatment outcomes.MethodsFifteen patients who underwent internal fixation (January 2000 to December 2015) were examined for radiological and clinical functional outcomes. The independent parameters evaluated were age, sex, extent of general injury, soft-tissue damage, surgical latency, and fracture type.ResultsAll fractures healed completely. Three patients developed osteoarthritis. The American Orthopaedic Foot and Ankle Society Ankle/Hindfoot Scale score was 79.5 ± 18.6, the Functional Foot Index score was 31.1 ± 31.4, and the physical and mental component summary scores of the Short Form 36, version 2, were 46.6 ± 11.8 and 50.3 ± 9.1, respectively. No influence on the above scores was determined.ConclusionsThe clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14 days) did not significantly lead to poorer outcomes in our patients.     

可吸收螺钉治疗距骨外侧突骨折

2002年1月～2007年9月,我科应用可吸收螺钉治疗距骨外侧突骨折11例,疗效满意。 1材料与方法 1．1病例资料本组11例（11足）,男7例,女4例,年龄19～55岁。左足5例,右足6例,均为闭合性损伤。     

Osteochondral fractures of the talus

Osteochondral fractures of the talus have become increasingly reported as awareness of this injury following ankle trauma has grown. Because hyaline cartilage does not have the ability to repair itself fully, surgical intervention is often necessary to create an optimal healing environment. Early recognition and appropriate diagnostic studies can aid the surgeon in producing favorable results.     

Avulsion fractures of the medial tubercle of the posterior process of the talus

Avulsion fracture of the medial tubercle of the posterior process of the talus occurs after forceful dorsiflexion-pronation of the ankle. We evaluated five patients who had sustained this fracture while participating in sporting activities. Two patients were correctly diagnosed acutely and treated with immobilization and limited weightbearing. Avulsion fractures in the remaining three patients went undiagnosed acutely. This group was treated with delayed operative excision for persistent posteromedial ankle pain. The patients were evaluated at a mean follow-up of 35 months using the AOFAS Ankle-Hindfoot Scale. The two patients diagnosed and treated acutely achieved excellent results. The three patients with missed fractures did poorly, yet achieved comparable results after late excision. Our results suggest that prompt diagnosis and appropriate management yields reliably good outcomes. Untreated avulsion fractures predictably do poorly. For these patients, late excision can provide significant functional and symptomatic improvement.     

Arthroscopic minimally invasive reduction for talus posterior process fractures;

Objective To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures. Methods The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation. Results There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] (P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] (P<0.05). Conclusion ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF. © 2023 Chinese Journal of Orthopaedic Trauma. All rights reserved.