Patient-Reported Outcomes After Lateral Process Talus Fracture

Abstract

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.

A retrospective analysis of the definitive management of open talus fractures at a major trauma centre, comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines

“…There are few reports that specifically assess open talus fractures, due to their rarity, resulting in a relative lack of understanding of the patient characteristics that sustain these injuries. To our knowledge, the present study is the first to assess FAAM and EQ-5D-5L scores specifically in open talus fracture patients, and as expected, the median FAAM-ADL and FAAM-sport score was lower in our cohort of open talus fractures (57 and 35, respectively), compared to another study on patients with lateral process talar fractures, where both open and closed fractures were included (FAAM-ADL = 89, FAAM-sport score = 77) [31]. A recent study by Liu et al analysed 51 patients at a level one trauma centre and provided important insight on the epidemiology of open talus fractures [22].…”

Lateral process fracture of the talus in a basketball player treated with arthroscopic reduction-internal fixation: a case report

“…Especially in Type I fractures, where the dislocation of the bone fragment is >2 mm, open reduction-internal fixation is recommended [ 7 ]. There have been several recent reports of open reduction-internal fixation for Type I fractures with satisfactory results have been reported [ 10–12 ]. However, an open approach carries a higher risk of complications such as infection, skin necrosis, nerve damage, and talar necrosis [ 13 ].…”

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

“…Those who were treated conservatively had a 38% chance of moderate or severe symptoms and 47% required later surgery [ 15 ]. In another study, Ross et al [ 16 ] reported a failure rate of 67% after conservative treatment and concluded that patients treated with early surgery have significantly fewer subtalar fusions as compared to patients with nonoperative treatment. Only nondisplaced, small-fragment, and extra-articular fractures could be treated conservatively [ 17 ].…”