Fractures of the Lateral Process of the Talus

Tinner, Christian; Sommer, Christoph

doi:10.1016/j.fcl.2018.04.009

Cited by 12 publications

(13 citation statements)

References 22 publications

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“…4 Treatment algorithms for these fractures have been previously described in the current literature. 5,6 In a case series and literature review, Wijers et al 7 suggest surgical fixation for all but nondisplaced, small-fragment, and extraarticular fractures. Fractures are classified using the McCrory and Bladin classification, which was based on the Hawkins classification scheme: type 1 fractures do not involve the articular surface, type 2 fractures involve the subtalar and talofibular joints, and type 3 fractures are those with comminution.…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes After Lateral Process Talus Fracture

Ross

Marchand

Cardon

et al. 2021

Journal of Orthopaedic Trauma

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Objectives: To evaluate functional outcome after lateral process talus fracture using patient-reported instruments and identify injury characteristics that portend a worse prognosis.Design: Retrospective case series.Setting: Level 1 academic trauma center.Patients/Participants: Fifty-three patients with isolated lateral process talus fracture and 12 months of minimum follow-up.Main Outcome Measurements: Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and Foot and Ankle Ability Measure (FAAM).Results: Mean patient age was 33 years (range, 17-62 years), and mean follow-up was 6.5 years (range, 1-12 years). Twenty-one patients were initially treated nonoperatively and 14 of these patients (67%) failed nonoperative management. Patients who failed nonoperative treatment more commonly had a displaced fracture (12 patients) (P = 0.009). Thirty-two patients had displaced fracture and were treated with early operative fixation. For the entire cohort, final PROMIS PF was 55 (SD 28.3), FAAM Activities of Daily Living (ADL) was 89 (SD 214), and FAAM sport was 77 (SD 220). The patients treated with operative fixation had significantly larger fracture fragments (2050 vs. 1066 mm 3 , P = 0.017). There was no difference in final outcome between operative and nonoperative patients for PROMIS PF (P = 0.84), FAAM ADL (P = 0.95), or FAAM sport (P = 0.94). There were significantly more subtalar fusions in the nonoperative group (4 patients) as compared to the operative group (one patient) (P = 0.05).Conclusions: Most patients with lateral process talus fracture achieve excellent outcome as measured by the PROMIS PF and FAAM at medium-term follow-up. Displaced fractures are likely best managed with early surgical treatment. Patients treated with early surgery have significantly fewer subtalar fusions as compared to patients with nonoperative treatment.

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Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes After Lateral Process Talus Fracture

Ross

Marchand

Cardon

et al. 2021

Journal of Orthopaedic Trauma

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“…Los patrones con fragmentación intercalar necesitan del aumento con una placa, por lo general, en "T" de 2,0 mm en función de soporte. [8][9][10] Si se detecta inestabilidad subastragalina residual, se sugiere la estabilización transarticular transitoria con dos clavijas, que se mantienen, por lo menos, 21 días. 10 Por último, en las lesiones grandes con fragmentación completa, se pueden considerar la escisión del proceso si el volumen resecado no supera los 5-10 cm 3 , 11 o la artrodesis subastragalina primaria si el compromiso es mayor.…”

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“…5,6 La decisión terapéutica se basa en la morfología anatómica de la lesión, la cual se considera en todas las clasificaciones que intentan protocolizar su manejo. [7][8][9] La sugerida por Macklin Vadell reconoce cuatro tipos principales: tipo 1, una variante avulsiva a pequeño fragmento de la porción anteroinferior del proceso; tipo 2, una variante a fragmento intermedio o grande de trazo simple no desplazada o con desplazamiento >2 mm; tipo 3, una variante a fragmento intermedio o grande con conminución o fragmentación, la cual puede ser solo articular, solo metafisaria, o afectar a la totalidad del proceso; y tipo 4, una variante asociada a inestabilidad o subluxación subastragalina (Figura 6). 10 El manejo conservador se reserva solo para las pequeñas avulsiones sin compromiso articular o para las fracturas de trazo simple sin desplazamiento, con un esquema que contempla protección de la carga durante, al menos, seis semanas, y ejercicios de movilidad activos y pasivos a partir de la tercera semana.…”

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“…En el resto de las situaciones y, debido a que el desplazamiento suele ser la regla, el tratamiento es quirúrgico. [7][8][9][10] El acceso artroscópico a través de dos portales anterolaterales ventral y dorsal puede ser una opción tanto para la resección y el desbridamiento de lesiones intrarticulares de pequeño tamaño, como para la fijación de fragmentos intermedios o grandes con mínimo desplazamiento inicial. 7 La cirugía a cielo abierto es la técnica preferida para las lesiones de mayor tamaño desplazadas a través de un acceso transverso de Ollier o de un acceso longitudinal lateral ligeramente incurvado hacia el cuboides, como el del caso presentado.…”

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Resolución del caso

Segura,

Lucero Zudaire,

Quiroz

et al. 2024

Rev. Asoc. Arg. Ort. y Traumatol

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“…In some cases, the calcaneofibular ligaments have also been reported to be ruptured [ 7 ]. However, some cadaveric biomechanical studies proposed that LTPFs could also be caused by dorsiflexion of the foot with associated eversion or external rotation [ 8 ]. To our knowledge, little clinical evidence has been provided to support this injury mechanism.…”

Section: Introductionmentioning

confidence: 99%

Fracture of the lateral process of the talus with associated deltoid ligament injury: a report of 2 cases

Jin

Xiao

et al. 2022

BMC Surg

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Background Fractures of the lateral process of the talus (LTPF) are rare and only rarely are associated ligamentous injuries. The injury mechanism is commonly considered to be similar with ankle sprains, where excessive varus of the hindfoot leads to avulsion fractures of the lateral process of the talus. However, previous cadaveric studies have suggested that LTPF was more likely to be caused by eversion or external rotation force with dorsiflexion of the ankle. But no clinical evidence has been provided. Case presentation Two patients presented to the emergency department with ankle pain after ankle eversion or external rotation. Physical examination revealed tenderness and swelling on both medial and lateral sides of the ankles. Plain radiographs and computed tomography revealed LTPF and medial soft tissue swelling, and magnetic resonance imaging confirmed a discontinuity of the deltoid ligament in Case 1. Surgical exploration revealed rupture of the superficial layer of the deltoid ligaments with intact deep layer in both patients. Treatment included fixation of the lateral process of the talus with headless compression screws and repair of deltoid ligaments. Both patients achieved excellent clinical outcomes 1 year post injury. Conclusion There are many possibilities of the injury mechanism of LTPF. These two cases provided clinical evidence that eversion or external rotation force, in addition to inversion, was also an important mechanism of LTPF.

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Fractures of the Lateral Process of the Talus

Cited by 12 publications

References 22 publications

Patient-Reported Outcomes After Lateral Process Talus Fracture

Patient-Reported Outcomes After Lateral Process Talus Fracture

Resolución del caso

Fracture of the lateral process of the talus with associated deltoid ligament injury: a report of 2 cases

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