It can also fracture and cause difficulty in diagnosis, but a CT or MRI scan can aid in differentiating the two conditions. 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. Fractures of the lateral and posterior processes are considered to be peripheral talar fractures. This joint allows for the up and down movement of your foot. Langer P, Nickisch F, Spenciner D, Fleming B, DiGiovanni CW. I. The lateral talocalcaneal ligament originates from the tip of this process.5. Romeo NM, Hirschfeld AG, Githens M, et al. Although plain radiographs serve as the gold standard for initial screening for bony injuries about the foot and ankle, the sensitivity for any talar injury is only 74%, with displacement being the largest driver of radiographic sensitivity. The fracture may sometimes be difficult to identify on radiographs and CT may be necessary to identify the fracture line. 3). Final fluoroscopic canale (A), mortise (B) and lateral (C) radiographs and an intra-operative photograph (D) displaying, 1. 4. The x-rays and other investigations such as CT or MRI scan can reveal the presence of other injuries that can occur in the vicinity. 2013;17 (04): 416-28. Currently the fractures are classified according to McCrory-Bladin into 3 types, with advice for treatment that is not ideal anymore. Mosby. Email: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (. 269 Chestnut St. #271 The vertical portion of the plate was cut at its end to create 2 tines which are impacted superiorly onto the intact talus. The chronic fracture may then require a subtalar fusion. Your talus joins with your tibia and fibula (lower leg bones) to form your ankle joint. For patients with a talar neck fracture with associated lateral process fracture, an anterolateral approach to the talar neck is preferred with the proximal aspect of the incision created approximately 1 cm plantar to its typical location. Chip fractures: arising from the anterior and inferior portion of the posterior articular process involving only the subtalar joint and not extending into the talofibular articulation. In cases of an associated subtalar dislocation, up to 50% of patients may have an additional osteochondral injury. Evaluation of process fractures of the talus using computed tomography, Fractures of the lateral process of the talus: A clinical review. The fracture occurs when the foot is dorsiflexed and inverted, as can happen with snowboarding (hence the term "snowboarder fracture")1. Three patients with isolated lateral process and 9 patients who sustained a combined neck or body with lateral process fracture fractures developed radiographic evidence of subtalar arthritis. The chronic fracture may then require a subtalar fusion. This article proposes modifying the existing classificat J Orthop Trauma. Federal government websites often end in .gov or .mil. If surgery is indicated, the fracture area is opened up through an incision on the outside front of the ankle, and a screw or screws are placed into the fracture to stabilize it to a larger part of the talar body (Figure 2). The suggested mechanism is thought to be a consequence of forced dorsiflexion and inversion of a fixed pronated foot.5 This results in a lateral shift of the talar head, an upward shift of the lateral process of the talus on the posterior articular surface of the calcaneum and loss of congruity of the posterior articulation.8 Boon et al, in their cadaveric study, proposed that some degree of external rotation is also required to produce this type of injury.9 Funk et al, in another cadaveric study, suggested that a combined eversion and dorsiflexion might also play an important role resulting in these fractures.10 However, there is no disagreement that dorsiflexion plays the key role at the time of injury. 6. However, for certain fractures such as minimally displaced fractures or very simple neck fractures, it can be used as the sole approach. The lateral tubercle, known as Stiedas process, projects more posteriorly than medially. Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. 2. An official website of the United States government. - fractures larger than 1 cm and frx w/ more than 2 mm displacement probably should be treated surgically; 110 West Rd., Suite 227 It is often 3-6 months or more before a full recovery is achieved. Pathology Location. The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon. Abstract Background: Lateral process fractures of the talus are a rare injury with significant associated morbidity when missed. Bilateral os trigona are seen in 2% of individuals 3. Sagi HC, Papp S, DiPasquale T. The effect of suture patten and tension on cutaneous blood flow as assessed by laser flowmetry in a pig model. Failure to detect the fracture may lead to non-union,ankle instability, and accelerated osteoarthritis. J Orthop Trauma. DiGiovanni CW, Langer PR, Nickisch F, et al. The posteromedial approach involves a curved incision halfway between the medial malleolus and the margin of the Achilles tendon. 2 Fractures of the tubercles of the posterior talar process are considered rare. Data is temporarily unavailable. entire . Snowboarder's ankle, Posteromedial process fractures of the talus. 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. Type 3b fractures require open reduction and internal fixation or excision of the comminuted fragments, depending on the size of the fragments.3,5,21,25,26 Factors determining the outcome are the presence of associated foot and ankle injury, the force injury, and late diagnosis.8. Intra-articular fractures of the entire posterior process have been associated with a poor outcome due to the higher incidence of malunion and early degenerative changes.3,5,23,31,36 In conservatively treated cases, up to one-third may develop avascular necrosis.5 Up to 75% of patients initially treated conservatively may subsequently require excision of the fragments in case of posteromedial tubercle fractures. Mosby. J Bone Joint Surg Am. The first is forced hyperplantarflexion and inversion causing direct compression of the posterior talus between the posterior tibial rim and the dorsal rim of the posterior facet of the calcaneum.5,31,33,34 The second assumption is that the posterior talofibular ligament causes an avulsion fracture of the lateral tubercle during hyperdorsiflexion and inversion motion.5,8,33,35 Cedell described the posteromedial tubercle fracture as an avulsion injury resulting from forced pronation and dorsiflexion of the foot.28,30,32 Other proposed mechanisms include direct trauma to the posteromedial facet, impingement of the sustentaculum tali in supination and forced dorsiflexion in cases of high-energy trauma.19,36, Patients usually present with swelling and pain in the hindfoot area. The reduction technique remains the same, and the plate is contoured onto the lateral process to provide fixation. The displaced lateral process cortical fragments are then reduced to the intact talus using a combination of dental picks and small pointed reduction clamps. Significance of, 7. 6. The undersurface of the combined tubercles articulates with 25% of the posterior facet of the calcaneum.5,30,31. 1). 1. Contact characteristics of the subtalar joint: the effect of talar neck misalignment. Failure to detect the fracture may lead to non-union,ankle instability, and accelerated osteoarthritis. It sits posterior to the talus on the lateral foot radiograph and represents a failure of fusion of the lateral tubercle of the posterior process. Recognition of the unique talar anatomy is important for correct diagnosis. The posterior talar process is composed of a medial tubercle and a larger lateral tubercle. Lateral talar process fracturesor snowboarder fractures are talusfractures that can mimic a lateral ankle sprain. Fixation of these fractures is critical to restore the native architecture of these joint surfaces. If the fracture fragments were just cleaned out (debrided), then weight bearing can be started once the patient feels comfortable. A positive V sign is an interruption of the contour of the LTP. CT scanning is essential in all suspected cases and can aid in management planning. Abstract Summary: Lateral process fractures of the talus may occur either in isolation or in combination with a talar neck or body fracture. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. H. Majeed, Wrightington Hospital, Hall Lane, Wigan WN6 9EP, UK. 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. The lateral tubercle provides attachments to the posterior talocalcaneal and posterior talofibular ligaments. 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. FRACTURE OF THE LATERAL PROCESS OF THE TALUS. 2004;86A:16161624. III. The lateral process of the talus has a large base that articulates with the fibula dorsolaterally and contributes to maintaining the ankle mortise. 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). It forms the lateral portion of the subtalar joint articulating with the posterior facet of the calcaneum inferomedially. 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. Unable to process the form. Please try again soon. J Bone Joint Surg Am. Treatment is generally nonoperative with immobilization for minimally displaced injuries and surgical reduction and fixation for displaced and intra-articular fractures. As many as 40-50% of fractures are missed on radiographs due to overlapping osseous structures 2. Missed fractures can lead to persistent pain and reduced function. An avulsion fracture is caused by tension on the bifurcate ligament during forceful . Radiographics. 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. - whether treated operatively or non operatively, many patients will develop subtalar arthrosis & may require late sub-talar arthrodesis. In this case, it may be necessary to remove these bone fragments by cleaning out these fragments (debridement) of the ankle. 5. Jibri Z, Mukherjee K, Kamath S et-al. 1. Mukherjee SK, Pringle RM, Baxter AD. The posterior process is further subdivided into posterolateral and posteromedial tubercles. The os trigonum is another normal variant due to non-fusion of the lateral tubercle ossification center. Search for Similar Articles 3. The aim of this study was to evaluate treatment and long-term outcomes of LPFT through a review of the literature. 5). Reference article, Radiopaedia.org (Accessed on 03 Jun 2023) https://doi.org/10.53347/rID-37891. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The medial tubercle is usually smaller but variable in size. Ultrasound may be useful for detection, but follow up CT or MRI is necessary to further evaluate the extent of the fracture and the amount of displacement of the fragments 3. 1998;26:271277. Over a 5-year period, this technique was performed on 21 patients (22 fractures) with greater than one-year follow-up. Morrison WB, Sanders TG. CT scans are helpful in cases of high clinical suspicion. Clinically, up to 40% to 50% of lateral process fractures can be missed due to similar presentation as ankle sprains, even in the absence of distracting injuries.11,12 A history of ankle sprain and the presence of associated acute localized tenderness, swelling and haematoma around the tip of the lateral malleolus, along with painful range of motion, should raise the suspicion of a lateral process fracture.5,13, Plain radiographs of the ankle in anteroposterior, lateral and mortise views should be performed routinely. Lateral process of talus fracture Case contributed by Craig Hacking Diagnosis certain Share Add to Citation, DOI, disclosures and case data Presentation Inversion injury. Limited subtalar visualization with arthroscopy or fusion procedures can also utilize this direct lateral approach. 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. Preoperative AP (A) and lateral (B) radiographs of a. Lateral talar process fractures (LTPF) are uncommon injuries but have become more relevant with snowboarding. lateral process, posterior process, talar process, Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance, Fractures of the lateral process of the talus, Relation between the occurrence of bony union and outcome for fractures of the lateral process of the talus: a case report and analysis of published reports, Fracture of the lateral process of the talus. Typically, recovery time from surgery requires six to eight weeks of relative immobilization and non-weight bearing, if the fracture has been stabilized (fixed with screws). The talus is shaped like a truncated cone and is wider anteriorly than posteriorly. This inferior articular surface is often impacted and must be corrected to prevent alteration of loading normal force distribution across the subtalar joint. Kirkpatrick DP, Hunter RE, Janes PC, Mastrangelo J, Nicholas RA. Fractures of the lateral process of the talus (LTPF), also known as "snowboarder's ankle", are very rare in the general population [].Of all fractures, 0.1-0.85% are talar fractures and only 10.4-20% of these involve the lateral process [2, 3].Most LTPF are isolated fractures and only rarely are associated ligamentous injuries [].The mechanism of this injury is traditionally presumed . and transmitted securely. 1. Reference article, Radiopaedia.org (Accessed on 03 Jun 2023) https://doi.org/10.53347/rID-31923, View Matt A. Morgan's current disclosures, see full revision history and disclosures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, fractures have been graded by a three point scale, grade 2 fractures may be further subdivided into, cortical disruption of the lateral talar process (best seen with a coronal approach). Cite this article: EFORT Open Rev 2018;3:85-92. Displaced fractures, depending upon their size, can either be excised or fixed with small screws. Mayo KA. Highlight selected keywords in the article text. {"url":"/signup-modal-props.json?lang=us"}, Morgan M, Hacking C, Bell D, et al. Fracture of the lateral process of the talus (LPFT) is a frequently overlooked injury that can lead to severe complaints if not treated adequately. Data sources: The data regarding aetiology, investigation, and management of these fractures were obtained through a comprehensive literature review utilising the Medline . Once anatomic reduction is achieved, 0.45 Kirschner wires are placed to hold the fragment(s) in place. A case report, https://creativecommons.org/licenses/by-nc/4.0/, https://radiopaedia.org/cases/anatomy-of-the-talus, Arthroscopic assessment of chondral lesion, Fracture associated with subtalar dislocation, Emergency reduction, subsequent arthroscopic assessment of chondral lesion. Canale ST, Beaty JH. The surgeon typically uses a headlamp to further improve visualization. 12. An os trigonum appears rounded, corticated and is found in 7% to 10% of the normal population. The fracture may sometimes be difficult to identify on radiographs and CT may be necessary to identify the fracture line. 4. The https:// ensures that you are connecting to the Inclusion in an NLM database does not imply endorsement of, or agreement with, (i.e.lateral process of the talus, anterior process of calcaneus, sustentaculum tali of calcaneus,base of the fifth metatarsal, and posterior malleolus of the tibia) Assess for traumatic malalignment and ankle syndesmotic injury: Examine the medial and lateral ankle mortise on dedicated mortise view for symmetry. 1987;2:4253. How common are they and how do they occur Some error has occurred while processing your request. The posterior process of the talus is composed of medial and lateral tubercles, separated by the groove for the flexor hallucis longus tendon. 1).1,2 These fractures are often under-appreciated, with a misdiagnosis rate of 15% and up to 21% being overlooked by radiographs alone.2,3 Lateral process fractures are often associated with talar neck fractures with such associated fractures occurring in up to 19.6% of patients who sustain a talar neck fracture.4 To delineate this specific neck fracture pattern, which incorporates the anterior body, some authors have used the term vertical fracture of the talus as noted by Mayo.5 Recently, it was shown that patients who had a lateral process fracture in addition to a talar body or a neck fracture have increased rates of subtalar arthrosis compared with patients who do not have lateral process involvement. Towson, MD 21204 Problem Solving in Musculoskeletal Imaging. Only a small number of case series' and reports are available and the appropriate management of these fractures is not really known. Sangeorzan BJ, Wagner UA, Hrrington RM, et al. Careers, Unable to load your collection due to an error. ISBN:0323072437. 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. A fracture should be suspected when there is soft tissue swelling inferior to the lateral malleolus. The posterolateral approach involves a longitudinal incision between the lateral border of the fibula and the Achilles tendon. HAWKINS LG. Problem Solving in Musculoskeletal Imaging. Many lateral talar process fractures are displaced or potentially unstable enough to require surgical fixation. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Benoudina S, Hacking C, et al. Lateral process fractures of the talus may occur either in isolation or in combination with a talar neck or body fracture. Suboptimal management is associated with pain and functional problems due to delayed healing, nonunion, degenerative changes and impingement. J Ultrasound Med. 1996;47: 1170-5. Ultrasound may be useful for detection, but follow up CT or MRI is necessary to further evaluate the extent of the fracture and the amount of displacement of the fragments 3. Occasionally, the fracture will be broken into many pieces (comminuted) that cannot be adequately fixed. Lateral process fractures of the talus are traditionally misdiagnosed as ankle sprains, and missed or untreated injuries can potentially lead to persistent symptoms. Data Trace is the publisher of Melenevsky Y, Mackey RA, Abrahams RB et-al. Lateral process fractures occur when the ankle is forced out to the side and are commonly seen in snowboarders. It articulates with the fibula dorsolaterally . Two mechanisms have been postulated. Sonographic diagnosis of talar lateral process fracture. Fractures of the Lateral Talar Process - Discussion: - two processes, lateral & posterior, project from body of talus; - either process may be fractured, either as isolated injury or assoc w/ other ankle or talar injuries; - it is frequently confused w/ an ankle sprain; - non union is a frequent complication of displaced lateral process frx; Non-operative treatment includes immobilization and protected weight-bearing for six weeks. Early diagnosis and timely management of these fractures are useful in order to avoid long-term problems of malunion, nonunion or severe subtalar arthritis. A diagnostic problem in ankle injuries], Diagnosis of medial tubercle fractures of the talar posterior process using oblique views, Naranja RJ, Jr, Monaghan BA, Okereke E, Williams GR., Jr, Open medial subtalar dislocation associated with fracture of the posterior process of the talus, Transchondral fractures (osteochondritis dissecans) of the talus, Tarsal tunnel syndrome caused by an unrecognized fracture of the posterior process of the talus (Cedell fracture). Fractures of talar posterior process have three types, namely an isolated fracture of either medial or lateral tubercle and a simultaneous fracture of medial and lateral tubercles (i.e. ADVERTISEMENT: Supporters see fewer/no ads. If the fracture is such that the piece that is broken remains close and not shifted or in other words completely non-displaced, it can be treated with relative immobilization of six weeks to allow adequate healing in a cast orwalker boots. These types of fractures should be treated with subtalar arthroscopy and excision, because the loose fragments may damage the articular surface.11,23,24 There have been no reports of instability of the subtalar or the ankle joints following the excision of these fragments.4, In Boack type 2 fractures, an arthroscopic assessment is recommended and, depending on the chondral damage and size of the comminuted fragments, arthroscopic debridement or arthroscopic-assisted reduction and internal fixation is preferred.1,2,5, In Boack type 3a fractures, the single large displaced fragment is best managed using arthroscopic or open reduction and anatomical fixation with headless compression screw, in order to achieve optimum outcome and avoid articular damage by the prominent head of the conventional screw (Figs 3a and and3b).3b). 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. All patients went on to unite their fracture without loss of reduction. to maintaining your privacy and will not share your personal information without Check for errors and try again. Orthopaedic Specialists of North Carolina. They can be seen fairly easily on a CT scan or MRI,one of which isoften ordered if there are questions as to the nature of the injury. 10. Overview What is a talus fracture? 2023 Lineage Medical, Inc. All rights reserved. 1a-Small (extra-articular) fragment of the lateral process of the talus; 1b-Small fragment of the isolated medial tubercle of the posterior process; 1c-Small (intra-articular) fragment of the lateral process of the talus. Romeo, Nicholas M. DO*; Benirschke, Stephen K. MD; Firoozabadi, Reza MD, *Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH; and. A laterally based small distractor is placed to provide distraction of the subtalar joint, with one pin in the fibula and one in the calcaneus. Ebraheim NA, Skie MC, Podeszwa DA, Jackson WT. A compressive fracture occurs by impaction of the anterior process from the cuboid and talus during eversion and dorsiflexion, which is referred to as a "nutcracker" lesion, or by forceful abduction of the forefoot with the heel fixed to the ground [30, 31]. 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. - small comminuted fragments: treated with excision of fragments; - Complications: 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. Bethesda, MD 20894, Web Policies A comprehensive review of the unique anatomy and vascular supply of the talus and patterns of talar fractures and dislocations is meant to provide radiologists with a high-yield resource for identifying and differentiating between different types of talar injuries to facilitate proper management. Lateral process fractures are usually a consequence of forced dorsiflexion and inversion of fixed pronated foot. Talar neck fractures: results and outcomes. The average follow-up was 24 months (range, 1264 months). 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. It is essential to understand these anatomical features of the talus in order to understand the anatomy of its fractures and their surgical management. Snowboarder's. 2004;24 (4): 1009-27. Patients with an associated subtalar dislocation have been reported to have the worst outcomes.5,29, Non-operative treatment has been reported to result in good outcomes in up to 60% of cases;4 however, a good outcome has been reported in all early and aggressively treated cases.4,6 Severe degenerative subtalar joint changes have been reported to occur in 10% to 15% of patients requiring subsequent subtalar arthrodesis.6,11,12,21 Nonunion has been reported in 60% of cases managed non-operatively,4,6 compared with 5% of cases following an early surgical intervention. ICMJE Conflict of interest statement: None declared. They are uncommon and frequently missed due to difficulty in visualizing them on plain radiographs and low level of suspicion. A talus fracture is a break in this bone. Get new journal Tables of Contents sent right to your email inbox, Technique for Open Reduction and Internal Fixation of Lateral Process Talus Fractures, Articles in PubMed by Nicholas M. Romeo, DO, Articles in Google Scholar by Nicholas M. Romeo, DO, Other articles in this journal by Nicholas M. Romeo, DO, Fractures of the Talus: State of the Art, Significance of Lateral Process Fractures Associated With Talar Neck and Body Fractures, Posteromedial Talar Body Fracture: Case Discussion and Surgical Technique, Patient-Reported Outcomes After Lateral Process Talus Fracture, Analysis of 101 Mechanical Failures in Distal Femur Fractures Treated with 3 Generations of Precontoured Locking Plates, Privacy Policy (Updated December 15, 2022). Case 2: talar dome Case 3: lateral and posterior process fractures Case 4: Pediatric talus body fracture Furthermore, impaction of the articular component of the fracture is not uncommon and must be addressed. 2013;17 (04): 416-28. The lateral tubercle is the one most usually seen on a lateral radiograph of the ankle. Screws are then sequentially placed in the plate to provide compression of the fragment(s) to the intact talus. This could occurwhen a snowboarder stops suddenly, for example. Sonographic diagnosis of talar lateral process fracture. Frequently missed findings in acute ankle injury. talar head fractures; talar neck fractures; talar body fractures. It is estimated to be present in ~7% of adults 1. At the time the article was created Matt A. Morgan had no recorded disclosures. 3. HAWKINS LG. J Bone Joint Surg. "snowboarder's talus"). Frequently missed findings in acute ankle injury. 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. The talus has seven articular surfaces and is divided into the head, neck and body, and two processes, the posterior process and the lateral process (Fig. Lateral process fractures are usually a result of high-energy injuries. A Stieda process is an anatomic variant defined as elongation of the lateral tubercle. 8600 Rockville Pike 5. 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. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Are you sure you want to trigger topic in your Anconeus AI algorithm? Reference article, Radiopaedia.org (Accessed on 03 Jun 2023) https://doi.org/10.53347/rID-31923, View Matt A. Morgan's current disclosures, see full revision history and disclosures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, fractures have been graded by a three point scale, grade 2 fractures may be further subdivided into, cortical disruption of the lateral talar process (best seen with a coronal approach). government site. 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. Type 1: a small chip or avulsion fracture (< 0.5 cm): Type 2: an intermediate fragment (0.5 to 1.0 cm) with some displacement: Type 3: a large fracture fragment (> 1 cm) with associated damage to both the ankle and the subtalar joints: Type 4: a severe form of fracture of either of the processes and associated instability or dislocation of the subtalar joint. Weight bearing is initiated 812 weeks after reduction and fixation. The type of treatment depends on the fracture grade 6: If symptomatic non-union occurs, debridement may be necessary. The piece that breaks off can vary in size and a single broken piece or many, and whether the pieces shifted away (displaced) or remain in place (non-displaced). A high index of suspicion is appropriate in cases of acute ankle sprains or persistent ankle pain after previous ankle injury. Debridement of subchondral debris after a fracture of the subtalar joint is also an indication . 9. cortical disruption of the lateral talar process (best seen with a coronal approach) tibiotalar joint space . For fractures in which interfragmentary compression is required, placement of multiple lag screws, using the plate as a washer, is likely to provide greater compression than single screw fixation. Minimally displaced or stable fractures: This type of fracture is barely out of place. 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