Management and classification of the fracture of lateral process of talus: An overview and literature update.

Fracture of the lateral process of the talus (FLPT) is uncommon in clinical practice and can be easily missed or misdiagnosed. In recent years, as researchers from all over the world have further deepened their research on FLPT, there has been a breakthrough in the classification, and the methods and principles of clinical management have changed accordingly; however, there is still no standardized guideline for the diagnosis and management of FLPT, and there have been few relevant literature review articles related to this kind of fracture in the past at least 5 years. In this article, we review the clinical classification, classification-based therapeutic recommendations, and prognosis of FLPT, with the aim of providing a reference for the clinical diagnosis and management of this infrequent fracture.

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

An open reduction-internal fixation is generally recommended in Type I lateral process fractures of the talus when the dislocation of the fragment is >2 mm. This report describes a case of a lateral process fracture of the talus in a 24-year-old male basketball player who underwent arthroscopic reduction-internal fixation. The patient complained of pain on the lateral aspect of his left ankle during a cutting motion. Based on physical examination and radiological findings, the patient was diagnosed with a lateral process fracture of the talus and underwent surgical treatment with arthroscopic reduction-internal fixation. At 12 weeks after the surgery, bone union was achieved, and the patient was able to resume playing basketball at his pre-injury level without symptoms, complications, or functional impairment. Lateral process fracture of the talus in a 24-year-old male basketball player was successfully treated with arthroscopic reduction-internal fixation.

Atypical Talus Fracture: A Case Report.

Introduction: Talus fractures are relatively rare injuries. These injuries are very serious because they can compromise the motion of foot and ankle and result in severe disability. Fractures of talar neck and body constitutes about 40% of all talus fractures. These occur secondary to high energy trauma most commonly motor vehicle collisions or fall from height. Fractures involving the lateral process results due to ankle inversion and dorsiflexion. Majority of talar surface is covered by articular cartilage and its role in force transmission between leg and foot makes successful treatment of such injuries a mandatory prerequisite to regain function. We present an atypical case of talus fracture in which fracture plane extends from posterior aspect of lateral talar process involving the body in coronal plane. Not much of literature has been published in this regard. Case Report: A 28 year old male presented with pain in the left ankle following fall from a tree. Following the radiological investigations, in coronal plane fracture line extends from posterior aspect of lateral talar process into the body medially and anteriorly. Internal fixation of the fracture was done by an open approach and a strict rehabilitation protocol was followed. At three months the patient had satisfactory healing of fracture without any irregularity of the articular surface and ambulant pain free with full range of ankle movements. Conclusion: There are several choices to treat talar fractures. The ideal treatment should be customized as per the fracture morphology. Open reduction and internal fixation is one of the best options to restore the tibiotalar and subtalar joint congruency and to prevent post traumatic arthritis. Appropriate diagnosis and perioperative treatment is the key to success in talar fracture management.

New Classification Based on CT and Its Value Evaluation for Fractures of the Lateral Process of the Talus.

This study aimed to develop a comprehensive classification system for fractures of the lateral process of the talus (LPTF) based on CT, and to evaluate its prognostic value, reliability and reproducibility. We retrospectively reviewed 42 patients involving LPTF with an average follow-up of 35.9 months for clinical and radiographic evaluations. In order to develop a comprehensive classification, a panel of experienced orthopedic surgeons discussed the cases. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classifications by 6 observers. The analysis of interobserver and intraobserver agreements was measured using kappa statistics. The new classification included 2 types based on presence of concomitant injuries or not, with type I consisting of 3 subtypes and type II of 5 subtypes. Average AOFAS score was 91.5 in the type Ia of new classification, 86 in type Ib, 90.5 in type Ic, 89 in type IIa, 76.7 in type IIb, 76.6 in type IIc, 91.3 in type IId, and 83.5 in type IIe. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ = 0.776 and 0.837, respectively), showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ 0.572 and 0.649, respectively) as well as McCrory-Bladin classification (κ = 0.582 and 0.685, respectively). The new classification system is a comprehensive one that takes into account concomitant injuries and shows good prognostic value with clinical outcomes. It is more reliable and reproducible and could be a useful tool for decision-making on treatment options for LPTF.

Accessory Anterolateral Talar Facet Syndrome After Treatment of Neglected Fracture of the Lateral Process of the Talus: A Case Report.

Fracture of the lateral process of the talus has often been missed or confused with lateral ankle sprain, and this can lead to long-term untreated cases of nonunion, malunion, and subtalar joint osteoarthritis. In a review of the published data, accessory anterolateral talar facet syndrome was not found after treatment of nonunion of the lateral process of the talus fracture. This report presents the case of a 40-year-old male snowboard instructor who suffered from a neglected fracture of the lateral process of the talus and was treated with open reduction using an iliac autogenous bone graft. Subsequently, partial resection of the anterior aspect of the process was required to treat the impingement syndrome that developed secondary to the united but enlarged lateral process. The patient resumed his activities a year after the second operation. We describe the consequences of misdiagnosis of the lateral process of the talus and its management.

Talus Secundarius: Case Series.

BACKGROUND: Talus secundarius is a very rare accessory bone at the lateral border of the foot. It is attached via a synchondrosis or small synostosis to the lateral aspect of the talar body and has additional facets to the tip of the lateral malleolus and the superior aspect of the calcaneus. METHODS: Over a period of 8 years, we have seen 5 patients with 6 cases of talus secundarius with an average age of 17 years at first presentation to the senior author. One ossicle was an incidental finding and completely asymptomatic. In the other 5 cases, the average duration of symptoms was 21 months at that time. In 3 cases, additional accessory bones were seen around the talus. RESULTS: The average size of the ossicles was 18 × 12 × 8 mm. Complete removal resulted in considerable pain reduction without further functional restriction in 4 cases. Two cases (1 asymptomatic, 1 with mild intermittent symptoms) were treated nonoperatively. The average Foot Function Index improved from 22.6 to 4.8 in all patients and from 31.0 to 4.5 in the patients treated with excision for symptomatic talus secundarius (P < .01). CONCLUSION: The knowledge of accessory bones at the foot is important, as missed diagnosis may lead to prolonged course of pain and unnecessary protection in the affected patients. Resection of symptomatic ossicles substantially reduces pain, but patients have to be counseled that some symptoms may prevail in a congenital deformity. LEVEL OF EVIDENCE: Level IV, prospective case series.

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

BACKGROUND: We 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. METHODS: Fifteen 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. RESULTS: All 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. CONCLUSIONS: The clinical outcomes of internal fixation of talar process fractures were good. Delayed surgical treatment (≥14days) did not significantly lead to poorer outcomes in our patients.

Clinical outcome and concomitant injuries in operatively treated fractures of the lateral process of the talus.

BACKGROUND: The aim of this study was to review the patient rated outcome (PROM) of surgically treated fractures to the lateral process of the talus (LPTF) and identify factors influencing the outcome. METHODS: Retrospective study with a current follow-up. Eligible were all patients treated surgically for a LPTF (n = 23) with a minimum follow-up of one year. Demographics, medical history, trauma mechanism, fracture characteristics, concomitant injuries, treatment details, complications, return to work and sports were assessed retrospectively. The current follow-up included the VAS FA, Karlsson Score, and SF-12. The primary outcome was the VAS FA. Secondary aim was the identification of parameters influencing the PROMs. RESULTS: 22 patients (96% follow-up) with a mean age of 32 ± 9 (18 to 49) years were included. 73% suffered a Hawkins Type 1, 23% a Type 2, and one patient a Type 3 fracture. 82% suffered concomitant injuries. 9% suffered minor surgical side infections, 50% developed symptomatic subtalar osteoarthritis. At final follow-up (44 ± 2 (12 to 97) months), the mean VAS FA Overall was 77 ± 21 (20 to 100), the Karlsson Score 72 ± 21 (34 to 97), and for the SF 12 the PCS 53 ± 8 (36 to 64) and the MCS 53 ± 7 (32 to 63). 50% of patients returned to their previous level of sports. Hawkins Type 1 fractures resulted in better VAS FA Overall score than Type 2 fractures. Posttraumatic subtalar osteoarthritis was the independent factor associated to a poor patient rated outcome (VAS FA, Karlsson Score). CONCLUSION: After a follow-up of over 3.5 years, surgically treated LPTF resulted in only moderate results. 50% suffered posttraumatic symptomatic subtalar osteoarthritis, which was the primary independent parameter for a poor outcome following LPTF. LEVEL OF EVIDENCE: Level III.

Talar process fractures: An overview and update of the literature.

Fractures of the lateral and the posterior processes of the talus are uncommon and frequently missed because of a low level of suspicion and difficulty in interpretation on plain radiographs. Missed fractures can lead to persistent pain and reduced function.Lateral process fractures are usually a consequence of forced dorsiflexion and inversion of fixed pronated foot. 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 fracture caused by the posterior talofibular ligament. CT scans are helpful in cases of high clinical suspicion.There is a lack of consensus regarding optimal management of these fractures; however, management depends on the size, location and displacement of the fragment, the degree of cartilage damage and instability of the subtalar joint. Non-operative treatment includes immobilization and protected weight-bearing for six weeks. Surgical treatment includes open reduction and internal fixation or excision of the fragments, depending on the size.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. Early diagnosis and timely management of these fractures help to avoid long-term complications, including malunion, nonunion or severe subtalar joint osteoarthritis. Cite this article: EFORT Open Rev 2018;3:85-92. DOI: 10.1302/2058-5241.3.170040.

Fractures of the Lateral Process of the Talus With Associated Ankle Instability: A Report of 2 Cases.

Fractures of the lateral process of the talus are uncommon, but often overlooked. They can result in significant functional deficit with residual nonunion and arthritis if not recognized and treated appropriately. We describe 2 cases of such injuries, one with acute recognition and management, and one with delayed diagnosis and nonunion. In both cases, pain from the fracture was accompanied by symptoms of instability requiring simultaneous lateral ligament reconstruction along with fracture fixation. Evaluation of patients with lateral process fractures should include assessment of the lateral ligaments; ankle instability may need to be surgically addressed along with intervention for fracture fixation. LEVELS OF EVIDENCE: Level IV: Case report.

The malleus cap: Anatomic description of cartilage of the lateral process of the malleus.

PURPOSE: To anatomically describe a cartilaginous cap attached to the lateral process of the malleus. STUDY DESIGN: Histologic and gross anatomic review. METHODS: Twenty temporal bones were histologically reviewed. The anatomical relationship between the tympanic membrane and malleus was then defined at the level of the lateral process of the malleus and the long process of the malleus. Separately, gross evaluation of these levels at the macroscopic level was undertaken through endoscopic imaging in five subjects. RESULTS: All temporal bones reviewed revealed the presence of a cartilaginous cap articulating between the tympanic membrane and the lateral process of the malleus. The cartilaginous cap was also readily identifiable in gross evaluation of the tympanic membrane from views lateral and medial to the tympanic membrane during endoscopic evaluation. CONCLUSION: The cartilaginous cap of the lateral process of the malleus is an important and reliable anatomical structure of the middle ear that has not previously been described. Through knowledge of the structure surgeons may exploit its presence by creating a cleavage plane between the cartilaginous cap and the malleus during tympanoplasty, possibly allowing for safer and more efficient surgery.

Treatment of Peripheral Talus Fractures.

Peripheral talus fractures include injuries to the lateral process, posteromedial talar body, and talar head. These injuries are rare and are often missed. Nonunion with conservative treatment is high and excision can lead to joint instability, rapid arthrosis, and earlier need for arthrodesis. Open reduction internal fixation of most peripheral talus fractures is critical to achieving a good outcome. Open reduction leads to more rapid union and ability to mobilize the ankle and subtalar joints, quicker revascularization of the talus, and lower rates of arthrosis. Surgical treatment can lead to substantial functional improvement and a slowing of the degenerative process.

Lateral Hindfoot Impingement After Nonunion of Fracture of the Lateral Process of the Talus.

Fracture of the lateral process of the talus is a relatively uncommon ankle injury, and the diagnosis is easily delayed. Lateral hindfoot impingement is characteristically related to chronic hindfoot valgus malalignment, with lateral ankle pain localized to the subtalar region. In a review of the published data, lateral hindfoot impingement after nonunion of fracture of the lateral process of the talus was not found. We present the case of a patient with such an injury. The patient was treated operatively and was followed for 18 months.

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.

Concomitant Fracture of the Lateral Process of the Talus and the Sustentaculum Tali of the Calcaneus / 대한정형외과학회잡지

Concomitant fracture of the lateral process of the talus and the sustentaculum tali of the calcaneus is a rare injury. There are few references in the literature that comment on the precise injury mechanism and the operative method for this type of fracture. We achieved satisfactory clinical results in 2 cases of concomitant fractures of the lateral process and the sustentaculum tali resulting from traffic accidents. We used a method of open reduction and internal fixation. We report these cases with a review of the relevant foreign literature because of no previous report in Korean literature.

Concomitant Fracture of Lateral Process and Posteromedial Tubercle of Talus: A Case Report / 대한족부족관절학회지

Concomitant fracture of medial tubercle of posterior process and lateral process of the talus has not been reported in Korean literature. Association between fracture of lateral and posterior process of talus is not clear. We treated with open reduction and screw fixation in fracture of lateral process and with excision of fragment of posteromedial tubercle of posterior process with satisfying result.