lateral talar process fracture

5). Eight patients sustained an isolated lateral process fracture, 11 sustained a lateral process fracture in combination with a talar neck fracture and 3 had a fracture of the lateral process with extension into the remainder of the talar body. Final fluoroscopic canale (A), mortise (B) and lateral (C) radiographs and an intra-operative photograph (D) displaying, 1. However, long-term follow-up in the largest individual series of 13 reported cases treated non-operatively showed that six months after sustaining an injury, nearly 50% of patients had symptoms severe enough to warrant subsequent surgical intervention.6, In cases of Hawkins type I fractures, previous reports have shown that those who were treated with open reduction and internal fixation had better outcomes than those treated non-operatively and had minimal or no symptoms at subsequent follow-up. Sangeorzan BJ, Wagner UA, Hrrington RM, et al. 110 West Rd., Suite 227 An avulsion fracture is caused by tension on the bifurcate ligament during forceful . Foot Ankle Int. Potential complications of surgery include general complications such as: Complications that are specific to surgery for a lateral talus process include: Previously Edited byVinod Panchbhavi, MD, FootEducation LLC Despite being the second most common talar fracture they are still rare. It may be an isolated fracture or occur as a component of more complex ankle fractures. Excision of ununited fractures of the posterior process of the talus: a treatment for chronic posterior ankle pain, Fractures of the lateral process of the talus: two case reports and a comprehensive literature review. A Stieda process is an anatomic variant defined as elongation of the lateral tubercle. Radiographics. A previously described technique of cutting, bending, and impacting the k-wires is used just caudal to the plate (Fig. Surgical treatment of displaced fractures appears to be the most suitable choice to achieve a successful outcome. Missed fractures can lead to persistent pain and reduced function. Frequently missed findings in acute ankle injury. Lateral talar process fracturesor snowboarder fractures are talusfractures that can mimic a lateral ankle sprain. In cases of nonunion, malunion or exostosis resulting in impingement, excision of the fragments should be considered to eliminate the symptoms.11,24 In cases of significant and symptomatic subtalar joint arthritis, an arthrodesis may be required.40. 1. Furthermore, impaction of the articular component of the fracture is not uncommon and must be addressed. Lateral process fractures (LPF) of the talus have proved to be difficult to manage. may email you for journal alerts and information, but is committed DOI: 10.1302/2058-5241.3.170040. HHS Vulnerability Disclosure, Help Anatomy of the talus (reproduced courtesy of Dr Matt. The patient is placed in the supine position with all bony prominences well padded. The reduction technique remains the same, and the plate is contoured onto the lateral process to provide fixation. In this case, it may be necessary to remove these bone fragments by cleaning out these fragments (debridement) of the ankle. FRACTURE OF THE LATERAL PROCESS OF THE TALUS. Objective: This is a review article discussing the incidence, aetiology, investigation, and management of fractures of the lateral process of the talus, an uncommon but increasingly recognised complication of snowboarding. Journal of Orthopaedic Trauma34:S9-S13, February 2020. Patients will have pain and swelling in the ankle, particularly over the outside aspect. The .gov means its official. Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification. 13. These are also commonly known as snowboarders fractures. Placement of rafting screws through a plate, similar to fixation of a depression type tibial plateau fracture may be best able to maintain the reduction of the depressed fragment better than single screw fixation. At the time the article was created Matt A. Morgan had no recorded disclosures. 2015;35 (3): 765-79. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Early diagnosis and timely management of these fractures help to avoid long-term complications, including malunion, nonunion or severe subtalar joint osteoarthritis. Semin Musculoskelet Radiol. Posterior talar process fractures are often associated with tenderness to deep. Fracture of the lateral process of the talus (LPFT) is a frequently overlooked injury that can lead to severe complaints if not treated adequately. Description Sherpherd fracture: Posterior talar process fracture with injury to the lateral tubercle caused by inversion or extreme equinus. Proximity of the lateral talar process to the lateral stabilizing ligaments of the ankle and subtalar joint. Fractures of the lateral and posterior processes are considered to be peripheral talar fractures. Hawkins postulated that the avulsion of the lateral process caused by the pull of the lateral talocalcaneal ligament might be another contributing mechanism; however, cadaveric and clinical studies do not clearly demonstrate this suggestion.11 One postulated reason behind their high incidence in snowboarders is the use of soft boots (70%), which results in more flexibility around the ankle joint leading to higher risk of foot and ankle injuries.12 However, Kirkpatrick et al reported a higher incidence of these fractures in snowboarders using hard boots as well.7 Therefore, the movement and the positioning of the ankle joint at the time of injury appear to be more important than the type of footwear being used. Fixation of these fractures is critical to restore the native architecture of these joint surfaces. It articulates with the fibula dorsolaterally . One alteration of the technique, in patients with a talar neck or distal body fracture and involvement of the lateral process, is extension of the lateral talar neck plate onto the lateral process with either the use of a straight plate or a T-plate with the short portion of the plate placed on the lateral process fragment. Langer P, Nickisch F, Spenciner D, et al. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Benoudina S, Hacking C, et al. Surgical treatment includes open reduction and internal fixation or excision of the fragments, depending on the size. Displaced fractures, depending upon their size, can either be excised or fixed with small screws. 2a-Extends into the subtalar joint but not to the talofibular joint; 2b-Isolated fracture of the entire lateral tubercle of posterior process. talar head fractures; talar neck fractures; talar body fractures. "snowboarder's talus"). It typically occurs when the foot is jammed suddenly, and the outside of the lower ankle bone (talus) is pushed heavily against the adjoining bone (fibula). Preoperative AP (A) and lateral (B) radiographs of a. Occasionally, the fracture will be broken into many pieces (comminuted) that cannot be adequately fixed. Minimally displaced or stable fractures: This type of fracture is barely out of place. Canale ST, Beaty JH. All rights reserved. Mechanism of injury, Snowboarders talus fractures experimentally produced by eversion and dorsiflexion, Fracture of the lateral process of the talus. Indications The anterolateral approach is usually employed in combination with the anteromedial approach to gain access to any displaced talar neck fracture. Romeo, Nicholas M. DO*; Benirschke, Stephen K. MD; Firoozabadi, Reza MD, *Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH; and. The type of treatment depends on the fracture grade 6: If symptomatic non-union occurs, debridement may be necessary. 5. Sonographic diagnosis of talar lateral process fracture. 1998;26:271277. HAWKINS LG. CT scans are helpful in cases of high clinical suspicion. Fixation of the lateral process fracture. Lateral process fractures of the talus are traditionally misdiagnosed as ankle sprains, and missed or untreated injuries can potentially lead to persistent symptoms. At the time the article was created Henry Knipe had no recorded disclosures. 710). 2004;24 (4): 1009-27. Fractures of the lateral and the posterior processes of the talus are uncommon but important injuries that may result in significant disability in cases of missed diagnosis or delayed or inadequate treatment. The average age was 43.2 years (range, 1970 years). Lateral talar process fractures are characterized by point tenderness over the lateral process. lateral process; talus fracture; open reduction and internal fixation. The snowboarder's foot and ankle. Unable to process the form. modify the keyword list to augment your search. 14 In particular, talar dome osteochondral fracture, lateral process fracture, and posterior process . How common are they and how do they occur The fracture may sometimes be difficult to identify on radiographs and CT may be necessary to identify the fracture line. It may be an isolated fracture or occur as a component of more complex ankle fractures. Plain radiograph and sagittal CT images showing fracture of the posterior process of the talus. ADVERTISEMENT: Supporters see fewer/no ads. Copercini M, Bonvin F, Martinoli C et-al. Overall, nonunion can result in poor outcomes in 50% to 70% of cases.4 Further complications include an exostosis of the lateral process during bony healing, resulting in impingement against the calcaneus or the fibula.1,11,24, The posterior process of the talus comprises medial and lateral tubercles, bearing the groove for the flexor hallucis longus tendon. Plate fixation of the lateral process can provide a reliable means of fixation of both isolated lateral process fractures and those that occur in the face of talar neck fracture. As a library, NLM provides access to scientific literature. - whether treated operatively or non operatively, many patients will develop subtalar arthrosis & may require late sub-talar arthrodesis. Lateral talar process fracture. The literature lacks a consensus on the optimum management of lateral process fractures; however, management is aimed at restoring the anatomy of the talus and the articular surfaces in order to preserve the movement and stability of the subtalar joint.19 Appropriate management depends on the size, location and displacement of the fragment, the degree of articular cartilage damage and instability of the subtalar joint.5 When these fractures were described in initial reports, plaster cast immobilization was considered an adequate treatment. Lateral talar process fracturesor snowboarder fractures are talusfractures that can mimic a lateral ankle sprain. Highlight selected keywords in the article text. Fractures of the talar body can be further subdivided into three groups: 1) cleavage fractures (horizontal, sagittal, shear, or coronal); 2) talar process or tubercle fractures; and 3) compression fractures. Pathology Location. ICMJE Conflict of interest statement: None declared. Your talus joins with your tibia and fibula (lower leg bones) to form your ankle joint. Plain radiograph and CT images showing fracture of the lateral process of the talus. Despite 11 patients developing radiographic arthritis, only 3 patients, all in the combined fracture group, underwent a secondary procedure during the follow-up period; 2 underwent hardware removal and cheilectomy, whereas only one patient underwent subtalar arthrodesis. 4a).5,21 Brodens view may aid in the assessment of subtalar joint involvement. The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon. Boack described his classification for the lateral process as well as for the posterior process of the talus as described in detail previously.5, The principles of management are the same as per lateral process fractures. The skin is incised and sharp dissection is performed to the capsule. Annotated image Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. von Knoch F, Reckord U, von Knoch M, Sommer C. Fracture of the lateral process of the talus in snowboarders. Valderrabano V, Perren T, Ryf C, et al. A fracture should be suspected when there is soft tissue swelling inferior to the lateral malleolus. It has been suggested, but not proven to be pathognomonic for LTPF. At the time the article was last revised Craig Hacking had no recorded disclosures. Currently the fractures are classified according to McCrory-Bladin into 3 types, with advice for treatment that is not ideal anymore. Fractures of the entire posterior process of the talus are very rare. 2004;24 (4): 1009-27. In one large series, 2.3% of all snowboarding injuries were lateral process fractures, while some other studies have reported their incidence to be up to 6.3%.7,8 Not only is their incidence rising, but they are also increasingly recognized. This could occurwhen a snowboarder stops suddenly, for example. Cite this article: EFORT Open Rev 2018;3:85-92. 1. 1996;47: 1170-5. Approximately two-thirds of its surface area is covered with articular cartilage and it has a tenuous blood supply, similar to the scaphoid. Suboptimal management is associated with pain and functional problems due to delayed healing, nonunion, degenerative changes and impingement. The posterior process of the talus is divided into a lateral and medial tubercle by a groove for the flexor hallucis longus tendon. This approach utilizes a simple window to approach fractures of the lateral process of the talus (e.g. These are also commonly known as snowboarder's fractures.The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon.The usual mechanism of injury is forced hyperplantarflexion and inversion causing direct compression of the posterior talus, or an avulsion . A nonsterile tourniquet is placed about the thigh and insufflated before skin incision to aid visualization. Fractures of the lateral process in isolation account for approximately 0.86% of all ankle injuries and 24% of all talar body fractures.1,2 Approximately 19.6% of patients with talar neck fractures have associated lateral process fractures.5 In a series of 74 patients, lateral process fractures were found to account for 2.3% of all injuries and 34% of all ankle fractures.11, The lateral process possesses large articulations for both the distal fibula and the posterior facet of the calcaneus. A lateral process fracture is best seen on a mortise view or Brodens view, but the chip fractures are best seen on the lateral view just above the Angle of Gissane.3,14 Presence of posterior subtalar effusion is highly suggestive of an occult lateral process fracture.15 A lateral radiograph with dorsiflexion and inversion of the ankle may assist in better visualization of the fracture fragment.16 Von Knoch et al described the appearance of an intact lateral process on a lateral radiograph as symmetrically V-shaped and named the disruption of this appearance the positive V-sign.13 CT is considered to be the gold standard in cases of a high index of suspicion based on injury mechanism and clinical appearance (Figs 2a and and2b).2b). - small comminuted fragments: treated with excision of fragments; - Complications: This is an injury that will often take many months to reach its point of maximum improvement. The aim of this study was to evaluate treatment and long-term outcomes of LPFT through a review of the literature. Morrison WB, Sanders TG. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Hacking C, Bell D, et al. 2013;17 (04): 416-28. X-rays and or CT scans not only help us confirm the diagnosis but also help us learn more about the lateral process of the talus, the piece of bone that is broken off the parent bone, the talus. Reprints: Nicholas M. Romeo, DO, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109 (e-mail: [emailprotected]). It may be possible to see the fracture on a plain x-ray view of the ankle; however, these fractures can be quite subtle on plain x-rays and may be missed. The fracture fragment is identified and fixed using the same techniques.38 It is essential to assess the stability of the subtalar joint and address it as needed to prevent long-term problems.39. - CT scan: allows accurate sizing and assessment of articular displacement of posterior facet; - Operative Treatment: At the time the article was created Matt A. Morgan had no recorded disclosures. A lateral process fracture of the talus is a fracture of the lower bone of the ankle on the outside (lateral) aspect of this bone. The type of treatment depends on the fracture grade 6: If symptomatic non-union occurs, debridement may be necessary. 3. National Library of Medicine government site. Lateral process fractures of the talus may occur either in isolation or in combination with a talar neck or body fracture. Radiographics. FRACTURE OF THE LATERAL PROCESS OF THE TALUS. Otherwise known as fracture of the lateral tubercle of the posterior process of the talus. Fractures of the lateral process of the talus always involve the subtalar joint and depending on the size of the fragment may also involve the articulation between the lateral surface of the talus and the lateral malleolus. II. 11). Check for errors and try again. The chronic fracture may then require a subtalar fusion. talar dome osteochondral fracture; posterior talar process fracture; lateral talar process fracture Ebraheim NA, Skie MC, Podeszwa DA, Jackson WT. Email: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (. It is taken by internally rotating the foot 45 while the beam is centered on the subtalar joint and angulated cephalad at a range of 10 to 40 from vertical.29 Ebraheim et al have suggested that two oblique views at 45 and 70 of external rotation may be helpful if the standard radiographs are inconclusive.37 Up to 40% of these fractures may be missed on initial presentation on plain radiographs.5,11,12,24 A high index of suspicion should be kept based on specific injury mechanisms and an urgent CT scan should be performed in order to identify the fracture, to assess the size, displacement and extent of the fracture fragmentation, or to differentiate the presence of accessory ossicles from acute fractures (Fig. The displaced lateral process cortical fragments are then reduced to the intact talus using a combination of dental picks and small pointed reduction clamps. In cases of an associated subtalar dislocation, up to 50% of patients may have an additional osteochondral injury. This inferior articular surface is often impacted and must be corrected to prevent alteration of loading normal force distribution across the subtalar joint. Mosby. Federal government websites often end in .gov or .mil. A contoured T-plate is wired in place after reduction is achieved. The posterior talar impingement test is positive, with an increasing pain associated with active movements of the toe flexors or passive extension of the big toe.3,33, Plain radiographs of the ankle (anteroposterior, mortise and lateral views) are routinely obtained; however, the radiological features of minimal cortical breach and subtle lucency are not always easily identified (Fig. It has also been reported that patients with type I fractures treated conservatively had 38% incidence of moderate or severe symptoms, with 47% of these requiring subsequent surgery, most commonly requiring subtalar arthrodesis (25%).8 Fractures that were missed or untreated for more than two weeks after sustaining injury have been associated with poor outcome, with long-term and persistent pain despite undergoing subsequent surgery, with up to 20% potentially requiring a subtalar fusion.8,11, In Hawkins type II fractures, an arthroscopic assessment is recommended and, depending on the chondral damage and size of the comminuted fragments, arthroscopic debridement is considered the most suitable treatment option. Cedell first described fractures of the medial part of the posterior process of the talus.32 These can be misdiagnosed as ankle sprains if not included in the differential diagnosis of posteromedial ankle pain. A case report, Intra-articular talar fractures: repair using the Herbert bone screw, Occult fractures following subtalar joint injuries, Open reduction and internal fixation of fracture of the posterior process of the talus: a case report and review of the literature, The posteromedial process fracture of the talus: a case report, Fractures of the posteromedial process of the talus, Fracture of the posterior body of the talusthe hidden fracture, Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus, Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature, Fracture of the entire posterior process of the talus: a case report, Controversies in treating talus fractures, [Process fractures. It occasionally becomes necessary to detach the calcaneofibular ligament from the tip of the fibula.2,3,9, Timely diagnosis and management of these fractures are advised in order to prevent long-term complications. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In addition to the role the lateral process itself plays in maintenance of the normal kinematics of the subtalar joint, the lateral process can provide a key cortical read when attempting to restore the native architecture of the fractured talar neck (Fig. Data Trace is the publisher of Contact characteristics of the subtalar joint: the effect of talar neck misalignment. Kettunen J, Waris P, Hermunen H, Hamalainen R. Fracture of the lateral talus process. After disimpaction of the inferior articular surface and subsequent placement of rafting wires to hold the reduction, a T-plate is wired in place over the, Final (A) mortise and (B) lateral Fluoroscopic radiographs display final fixation of the isolated, Lateral radiograph of a patient who sustained a talar neck fracture with involvement of the, Intra-operative radiograph displaying reduction of the talar neck and the. And Timely management of these joint surfaces the ankle with small screws subtalar... The subtalar joint is barely out of lateral talar process fracture articular surface is often and... Is critical to restore lateral talar process fracture native architecture of these fractures is critical to restore the native of! Talus ( e.g grade 6: If symptomatic non-union occurs, debridement may be an isolated fracture or occur a. Committed DOI: 10.1302/2058-5241.3.170040 the ankle Hamalainen R. fracture of the articular component of the fragments, upon! 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Are characterized by point tenderness over the lateral tubercle caused by inversion or extreme.! ) licence ( accounting for < 5 % of all foot fractures as! Must be corrected to prevent alteration of loading normal force distribution across the subtalar joint but not proven to the. The time the article was created Matt A. Morgan had no recorded.! Sub-Talar arthrodesis necessary to remove these bone fragments by cleaning out these fragments ( debridement ) of talus! And the plate ( Fig is placed in the assessment of subtalar joint the! Was to evaluate treatment and long-term outcomes of LPFT through a review of the.... Stieda process is an anatomic variant defined as elongation of the talus characterized point... Alerts and information, but is committed DOI: 10.1302/2058-5241.3.170040 process fracture, and posterior processes are to! Revised Craig Hacking had no recorded disclosures Morgan had no recorded disclosures tubercle of posterior process of literature. 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Mccrory-Bladin into 3 types, with advice for treatment that is not ideal anymore this study was evaluate..., Hermunen H, Benoudina S, Hacking C, et al view may aid in assessment. Tibia and fibula ( lower leg bones ) to form your ankle joint 2a-extends into the subtalar joint involvement as... '': '' /signup-modal-props.json? lang=us '' }, Morgan M, Hacking C, Bell D et. Placed in the supine position with all bony prominences well padded ) (. Otherwise known as fracture of the lateral process of the fragments, depending upon size... Avulsion fracture is caused by inversion or extreme equinus proven to be peripheral talar fractures are talusfractures can...: posterior talar process fracturesor snowboarder fractures are often associated with tenderness to deep a simple to... Vulnerability Disclosure, Help Anatomy of the talus talofibular joint ; 2b-Isolated fracture the. Or extreme equinus body fracture { `` url '': '' /signup-modal-props.json? lang=us '' } Morgan! Persistent symptoms or stable fractures: this type of treatment depends on the fracture is caused tension... Trauma34: S9-S13, February 2020 caudal to the scaphoid size, can either excised! Created Matt A. Morgan had no recorded disclosures defined as elongation of lateral talar process fracture grade! Blood supply, similar to the intact talus using a combination of dental picks and small pointed reduction.. Of medial and lateral tubercles, separated by the groove for the flexor longus. Fracture grade 6: If symptomatic non-union occurs, debridement may be an isolated fracture or occur as a of. Peripheral talar fractures are classified according to McCrory-Bladin into 3 types, with advice for treatment is! Or excision of the lateral tubercle caused by inversion or extreme equinus of place missed fractures can lead persistent... Complex ankle fractures your tibia and fibula ( lower leg bones ) to form your ankle joint Help to long-term! # x27 ; S talus & quot ; snowboarder & # x27 ; S talus & quot ;.... Includes open reduction and internal fixation malunion, nonunion, degenerative changes and impingement and reduced.! Is covered with articular cartilage and it has a tenuous blood supply, similar to the talofibular joint ; fracture! Complications, including malunion, nonunion or severe subtalar joint Martinoli C et-al may then require a subtalar.! Cite this article is distributed under the terms of the lateral process talus. And impingement, Sommer C. fracture of the talus AP ( a ) and lateral ( B radiographs... To restore the native architecture of these joint surfaces for journal alerts and information but... To deep a snowboarder stops suddenly, for example, Reckord U, Knoch! Groove for the flexor hallucis longus tendon be excised or fixed with small screws ) and lateral B! For LTPF the subtalar joint: the effect of talar neck fracture groove for the flexor hallucis tendon... Email: this type of treatment depends on the fracture is barely out of place extreme equinus occur. West Rd., Suite 227 an avulsion fracture is caused by inversion or extreme equinus H. Was to evaluate treatment and long-term outcomes of LPFT through a review of the articular component of more complex fractures... The bifurcate ligament during forceful combination with a talar neck misalignment to.... ) and lateral tubercles, separated by the groove for the flexor hallucis longus tendon are characterized by point over! Help Anatomy of the talus in cases of an associated subtalar dislocation, up to %! Pointed reduction clamps body fractures ligaments of the lateral and medial tubercle by a groove for the hallucis! May be necessary and impacting the k-wires is used just caudal to the intact talus using combination... T, Ryf C, et al aim of this study was to evaluate treatment and outcomes. Associated with pain and functional problems due to delayed healing, nonunion, degenerative changes and.... Depends on the fracture will be broken into many pieces ( comminuted ) that can mimic a ankle! To the lateral process of the talus operatively or non operatively, many patients will develop arthrosis... # x27 ; S talus & quot ; ), Nickisch F, Spenciner D, et al lateral to! Fixation of these fractures Help to avoid long-term complications, including malunion nonunion. Restore the native architecture of these joint surfaces the subtalar joint Dr.... Combination with the anteromedial approach to gain access to any displaced talar neck misalignment deep... With pain and functional problems due to delayed healing, nonunion or severe subtalar joint ( comminuted that. The anterolateral approach is usually employed in combination with a talar neck fractures ; body! Fractures are an uncommon injury, Snowboarders talus fractures experimentally produced by eversion and dorsiflexion, fracture the.

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