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Jiang JT, Wang X, Li J, Huang W. Ipsilateral talus and calcaneus fracture associated with deltoid ligament rupture and Peroneal tendon subluxion. Asian J Surg 2024; 47:2707. [PMID: 38609830 DOI: 10.1016/j.asjsur.2024.03.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/06/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Jian-Tao Jiang
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Xiao Wang
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Jianwen Li
- Department of Orthopedics, ShaoXing Shangyu Traditional Chinese Medicine Hospital, ZheJiang, 312300, China
| | - Weijun Huang
- Department of Orthopedics, ShaoXing Shangyu Third Hospital, ZheJiang, 312300, China.
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2
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Wang CQ, Stöckle U, Dong SN, Li XG, Ling ZX. Management and classification of the fracture of lateral process of talus: An overview and literature update. World J Clin Cases 2024; 12:2487-2498. [PMID: 38817221 PMCID: PMC11135440 DOI: 10.12998/wjcc.v12.i15.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/14/2024] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
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.
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Affiliation(s)
- Chao-Qun Wang
- Department of Traumatic Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei Province, China
| | - Ulrich Stöckle
- Center of Musculoskeletal Surgery, Berlin Charité Medical University Hospital, Berlin 13353, Germany
| | - Sheng-Nan Dong
- Department of Traumatic Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei Province, China
| | - Xu-Gui Li
- Department of Traumatic Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei Province, China
| | - Ze-Xi Ling
- Department of Traumatic Orthopedics, The Affiliated Hospital of Wuhan Sports University, Wuhan 430079, Hubei Province, China
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Wang R, You G, Yin S, Jiang S, Wang H, Shi H, Zhang L. Three-dimensional Mapping Analysis of Talus Fractures and Demonstration of Different Surgical Approaches for Talus Fractures. Orthop Surg 2024; 16:1196-1206. [PMID: 38485459 PMCID: PMC11062851 DOI: 10.1111/os.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures. METHODS We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure. RESULTS Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches. CONCLUSION Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.
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Affiliation(s)
- Ruihan Wang
- School of Physical Education, Southwest Medical UniversityLuzhouChina
- Department of RehabilitationYibin Integrated Traditional Chinese and Western Medicine HospitalYibinChina
| | - Guixuan You
- School of Physical Education, Southwest Medical UniversityLuzhouChina
| | - Shiqin Yin
- School of Physical Education, Southwest Medical UniversityLuzhouChina
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical UniversityLuzhouChina
| | - Hai Wang
- Department of Medical ImagingYibin Integrated Traditional Chinese and Western Medicine HospitalYibinChina
| | - Houyin Shi
- Department of OrthopaedicsThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Center for Orthopaedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Luzhou Key Laboratory of Orthopedic DisordersLuzhouChina
| | - Lei Zhang
- Department of OrthopaedicsThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Center for Orthopaedic Diseases ResearchThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
- Luzhou Key Laboratory of Orthopedic DisordersLuzhouChina
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Morimoto S, Morio F, Tachibana T, Iseki T. Lateral process fracture of the talus in a basketball player treated with arthroscopic reduction-internal fixation: a case report. J Surg Case Rep 2024; 2024:rjae220. [PMID: 38605692 PMCID: PMC11007640 DOI: 10.1093/jscr/rjae220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
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.
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Affiliation(s)
- Shota Morimoto
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Hyogo, Japan
| | - Futoshi Morio
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Hyogo, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Hyogo, Japan
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Jin XY, Xiao WY, He T, Dong YQ, Zhang C. Fracture of the lateral process of the talus with associated deltoid ligament injury: a report of 2 cases. BMC Surg 2022; 22:356. [PMID: 36195942 PMCID: PMC9533565 DOI: 10.1186/s12893-022-01781-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01781-y.
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Affiliation(s)
- Xiang-Yun Jin
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Wei-Yuan Xiao
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Tao He
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China
| | - Yu-Qi Dong
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China.
| | - Chao Zhang
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People's Republic of China.
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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 -8.3), FAAM Activities of Daily Living (ADL) was 89 (SD -14), and FAAM sport was 77 (SD -20). The patients treated with operative fixation had significantly larger fracture fragments (2050 vs. 1066 mm3, 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. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
Talus fractures result following high energy trauma and can lead to significant functional impairment. The complex morphology of the talus, it's multiple articulations and tenuous blood supply translate into significant challenges that must be overcome to achieve the best possible outcomes. Despite advances made in their management, they continue to have high complication rates. Nonetheless, restoration of normal alignment will optimise outcomes. In this article, we report on the epidemiology, anatomy, classification, patient evaluation and current evidence for the management of talus fractures.
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Affiliation(s)
- Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ.
| | | | - Ken Wong
- Royal National Orthopaedic Hospital, Stanmore, HA7 4LP
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Mui T, Sugimoto K, Sugioka S, Yamasaki T, Tanaka K, Isomoto S, Tanaka Y. Accessory Anterolateral Talar Facet Syndrome After Treatment of Neglected Fracture of the Lateral Process of the Talus: A Case Report. J Foot Ankle Surg 2021; 59:826-828. [PMID: 31982304 DOI: 10.1053/j.jfas.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/11/2019] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Takahiro Mui
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Nara Medical University, Kashiharashi, Nara, Japan.
| | - Kazuya Sugimoto
- Vice President, Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Narashi, Nara, Japan
| | - Shuhei Sugioka
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Narashi, Nara, Japan
| | - Tsuyoshi Yamasaki
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Narashi, Nara, Japan
| | - Kazunori Tanaka
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Narashi, Nara, Japan
| | - Shinji Isomoto
- Director, Department of Orthopaedic Surgery, Nara Prefecture General Medical Center, Narashi, Nara, Japan
| | - Yasuhito Tanaka
- Professor, Department of Orthopaedic Surgery, Nara Medical University, Kashiharashi, Nara, Japan
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Wijers O, Posthuma JJ, De Haas MBJ, Halm JA, Schepers T. Lateral Process Fracture of the Talus: A Case Series and Review of the Literature. J Foot Ankle Surg 2020; 59:136-141. [PMID: 31668959 DOI: 10.1053/j.jfas.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/23/2019] [Indexed: 02/03/2023]
Abstract
Fracture of the lateral process of the talus (LPFT) is a frequently overlooked injury that can lead to severe complaints if not treated adequately. The aim of this study was to evaluate treatment and long-term outcomes of LPFT through a review of the literature. Furthermore, we propose a modified classification based on severity and intra- or extra-articular location of LPFT. Patients diagnosed with LPFT and treated at a Level 1 trauma center between 2001 and 2018 were included. Fracture and treatment characteristics were recorded in combination with functional outcome and quality of life after a mean follow-up of 5.5 (range 0.8 to 17.2) years. A comprehensive literature search was performed to identify all case series regarding patients with LPFT; 36 patients were included. According to our modified classification, 1 patient had type 1A (2.8%), 6 patients had type 1B (16.7%), 10 patients had type 2 (27.8%), 11 patients had type 3 (30.6%), 6 patients had type 4A (16.7%), and 2 patients had type 4B (5.6%). Twenty-eight patients underwent operative fixation (78%). The median American Orthopaedic Foot and Ankle Society Hindfoot Score was 75 (range 12 to 100). The median Foot Function Index was 2 (range 0 to 9). The median score for the EuroQol-5D was 0.8 (range -0.5 to 1), and the median score for health status component was 75 (range 30 to 98). There is some room for conservative treatment of LPFT; however, we strongly believe that this should be considered only for nondisplaced, small-fragment, and extra-articular fractures. Surgical treatment leads to an overall good (long-term) outcome.
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Affiliation(s)
- Olivier Wijers
- Surgeon-in-Training, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Jelle J Posthuma
- Surgeon-in-Training, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Mathijs B J De Haas
- General Physician, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Jens A Halm
- Surgeon, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - Tim Schepers
- Surgeon, Trauma Unit, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
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Schwartz AM, Runge WO, Hsu AR, Bariteau JT. Fractures of the Talus: Current Concepts. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419900766. [PMID: 35097362 PMCID: PMC8697161 DOI: 10.1177/2473011419900766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Talus fractures continue to represent a challenging and commonly encountered group of injuries. Its near-complete articular cartilage surface, and its role in force transmission between the leg and foot, makes successful treatment of such injuries a mandatory prerequisite to regained function. Familiarity with the complex bony, vascular, and neurologic anatomy is crucial for understanding diagnostic findings, treatment indications, and surgical techniques to maximize the likelihood of anatomic bony union. This review details the structure and function of the talus, a proper diagnostic workup, the treatment algorithm, and post-treatment course in the management of talus fractures.
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Affiliation(s)
- Andrew M Schwartz
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - William O Runge
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
| | - Jason T Bariteau
- Department of Orthopedics, Emory University School of Medicine, Atlanta, GA, USA
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von Winning D, Lippisch R, Pliske G, Adolf D, Walcher F, Piatek S. Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years. Foot Ankle Surg 2020; 26:71-77. [PMID: 30554933 DOI: 10.1016/j.fas.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/20/2018] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Dominik von Winning
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany.
| | - Roland Lippisch
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Daniela Adolf
- Gesellschaft für klinische und Versorgungsforschung mbH, Halberstädter Str. 40a, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany
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Lau BC, Moore LK, Thuillier DU. Evaluation and Management of Lateral Ankle Pain Following Injury. JBJS Rev 2019; 6:e7. [PMID: 30153244 DOI: 10.2106/jbjs.rvw.17.00143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Brian C Lau
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Laura K Moore
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Daniel U Thuillier
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
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Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation. Magn Reson Imaging Clin N Am 2019; 27:701-719. [PMID: 31575401 DOI: 10.1016/j.mric.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
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Abstract
OBJECTIVES To determine whether fracture of the lateral process (LP) elevates the risk of development of radiographic subtalar arthrosis in patients with talar body and neck fractures. DESIGN Retrospective review. SETTING Level 1 academic trauma center. PATIENTS/PARTICIPANTS Eighty-two patients with 43 talar neck and 43 talar body fractures treated over a 5-year period. INTERVENTION Preoperative and postoperative radiographs were evaluated for fracture of the LP of the talus and subsequent development of radiographic subtalar arthritis. MAIN OUTCOME MEASUREMENTS Radiographic evidence of subtalar arthritis. RESULTS Seventy-six percent of talar neck fractures with involvement of the LP went on to develop radiographic evidence of subtalar arthrosis compared with 36% of talar neck fractures without LP involvement (P = 0.035). Thirty of the fractures involving the LP had a separate LP fragment. Fifteen of the 30 fractures with a separate LP fragment that underwent reduction and fixation developed radiographic evidence of subtalar arthrosis, whereas all 13 fractures with an independent LP fragment that did not have fixation of the LP went on to develop radiographic evidence of subtalar arthritis (P = 0.001). Comminution of the inferior talar articular surface was found to significantly increase the risk of radiographic subtalar arthritis in both talar body and talar neck fractures (P = 0.0003). An anatomic reduction of both talar neck and body fractures was found to be associated with a lower incidence of radiographic subtalar arthritis (P = 0.00001). CONCLUSION Comminution of the inferior articular surface of the talus elevates the risk of subtalar arthritis in patients with both talar neck and body fractures. Fracture of the LP is a marker for injury to the talar inferior articular surface and increases the risk for the radiographic finding of subtalar arthritis in patients with talar neck fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Helmig K, Treme G, Richter D. Management of injuries in snowboarders: rehabilitation and return to activity. Open Access J Sports Med 2018; 9:221-231. [PMID: 30349409 PMCID: PMC6188004 DOI: 10.2147/oajsm.s146716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Snowboarding has seen a continuous increase in popularity, leading to an increase in the number of snowboarding injuries seen in orthopedic practice. Upper-extremity injuries are more common than lower-extremity, spine, and pelvis injuries. In this review, we focus on the most common snowboarding injuries of the extremities, spine, and pelvis and provide an overview of their respective rehabilitation and return-to-sport protocols. Despite many of the injuries seen in snowboarding also occurring in other sports, objective data about rehabilitation and return to sport are lacking for many injuries. This provides an opportunity for research in the area with regard to many sports and many different injuries.
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Affiliation(s)
- Kathryn Helmig
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
| | - Gehron Treme
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
| | - Dustin Richter
- Department of Orthopaedic Surgery, University of New Mexico, Albuquerque, NM, USA,
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Abstract
Lateral talar process fractures (LTPF) are uncommon injuries but have become more relevant with snowboarding. Currently the fractures are classified according to McCrory-Bladin into 3 types, with advice for treatment that is not ideal anymore. This article proposes modifying the existing classification by differentiating the multifragmented type III into 3 subtypes: IIIa, articular multifragmented but metaphyseal simple; IIIb, articular and metaphyseal multifragmented but reconstructable; and type IIIc, comminuted and nonreconstructable. A treatment-algorithm is presented. Undisplaced fractures are usually treated conservatively and displaced are an indication for surgery. In general, the outcome is good to excellent, if timely diagnosed and adequately treated.
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Affiliation(s)
- Christian Tinner
- Departement of Surgery, Kantonsspital Graubünden, Loëstrasse 170, Chur 7000, Switzerland
| | - Christoph Sommer
- Departement of Surgery, Kantonsspital Graubünden, Loëstrasse 170, Chur 7000, Switzerland.
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Buza JA, Leucht P. Fractures of the talus: Current concepts and new developments. Foot Ankle Surg 2018; 24:282-290. [PMID: 29409210 DOI: 10.1016/j.fas.2017.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/09/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
Fractures of the talus are challenging to manage, with historically poor outcomes and a high rate of complications. The rare nature of this injury limits the number of studies available to guide treatment. Fortunately, a number of advancements have been made in the last decade. There is increased recognition regarding the importance of anatomic reconstruction of the osseous injury. Advanced imaging is used to assess the subtalar joint, where even slight displacement may predispose to arthritis. Increasing use of dual anteromedial and anterolateral approaches, along with plate fixation, has improved our ability to accurately restore the anatomy of the talus. Modification of the original Hawkins classification can both guide treatment and allow us to better predict which patients will develop avascular necrosis. Lastly, improved reconstructive techniques help address the most common complications after talus fracture, including arthritis, avascular necrosis, and malunion.
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Affiliation(s)
- John A Buza
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States
| | - Philipp Leucht
- NYU Langone Medical Center, Hospital for Joint Diseases, 301 E. 17th St., New York, NY 10003, United States.
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18
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Hörterer H, Baumbach SF, Mehlhorn AT, Altenberger S, Röser A, Polzer H, Walther M. [Fractures of the lateral process of the talus-snowboarder's ankle]. Unfallchirurg 2018; 121:715-722. [PMID: 29959450 DOI: 10.1007/s00113-018-0519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fractures of the lateral tubercle of the talus (PLT) are rare. With the increasing popularity of the trend sport snowboarding, the incidence of PLT fractures has increased. The most common classification of PLT fractures is the Hawkins classification. The aim of this review was to raise awareness for the injury and discuss the current evidence. A literature search revealed eight studies, each including at least seven patients. Six out of the eight studies were descriptive, retrospective case series without predefined treatment concepts. These resulted in only moderate treatment outcomes. Due to the low number of patients, the lack of computed tomography (CT) or magnetic resonance imaging (MRI) and inconsistent treatment approaches, these studies do not allow to draw conclusions on a treatment concept for PLT fractures. The other two studies validated existing treatment regimens. Overall, surgical treatment of dislocated fractures and conservative treatment of non-dislocated fractures was carried out with satisfactory results. The outcome of conservative treatment of dislocated factures remains unclear. A reason for the inconsistent treatment results could be the observed concomitant injuries, including dislocation of the tendons of the peroneus muscles (46%), calcaneal chondral injuries (48%) and subluxation of the subtalar joint (7%). Based on the limited evidence available, the authors recommend the application of CT and MRI for PLT fractures to assess concomitant injuries, which are the primary indication for surgery. Dislocated type I and II fractures (>2 mm) should be treated operatively, type III and non-dislocated type I and II fractures can be treated conservatively by immobilization and partial weight-bearing for 6 weeks.
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Affiliation(s)
- H Hörterer
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland.
- PMU Salzburg, Strubergasse 21, 5020, Salzburg, Österreich.
| | - S F Baumbach
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - A T Mehlhorn
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - S Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - A Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - H Polzer
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, München, Deutschland
| | - M Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
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Abstract
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
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20
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Caracchini G, Pietragalla M, De Renzis A, Galluzzo M, Carbone M, Zappia M, Russo A, Greco F, Miele V. Talar fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:151-165. [PMID: 29350644 PMCID: PMC6179081 DOI: 10.23750/abm.v89i1-s.7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/23/2022]
Abstract
Introduction: The talus is the second largest bone of the foot. It is fundamental to ensure normal ankle-foot movements as it connects the leg and the foot. Talar fractures are usually due to high energy traumas (road accidents, high level falls). They are not common as they account for 3-5% of ankle and foot fractures and 0.85% of all body fractures. However, talar fractures not correctly diagnosed and treated can lead to avascular necrosis of the astragalus, pseudoarthrosis, early osteoarthrisis and ankle instability, declining the quality of life of patients. Methods: A PubMed search was performed using the terms “talus” “talus AND radiology”, “talar fractures”, and “talar fractures classification”, selecting articles published in the last 98 years. We selected articles about pre-treatment and post-surgery talar fractures diagnostic imaging. We also selected articles about talar fractures complications and traumatic talar dislocations. Case reports have not been included. Aim of the work: to describe radiological evaluations, classification systems, and biomechanical patterns involved in talar fractures. Also we will briefly describe talar fractures complications and treatment option and strategies. Conclusions: This work suggests a radiological approach aimed to classify talar fractures and guide treatment strategies, improving patient outcomes. (www.actabiomedica.it)
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21
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Abstract
Talus fractures are rare orthopedic injuries. Surgical fixation is challenging for treating surgeons. The clear majority of fractures require operative treatment. The indication and use of plates in fixation of talus fractures are reviewed. Specific applications including fractures of the lateral process, posterior fractures, extreme comminution, bone grafting, and spring plating to hold key segments are reviewed in this article.
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Affiliation(s)
- Michael Swords
- Michigan Orthopedic Center, Sparrow Hospital, Lansing, MI, Department of Surgery, USA,Address for correspondence: Dr. Michael Swords, Michigan Orthopedic Center, 2815 S Pennsylvania Ave Ste 204, Lansing, MI 48823, USA. E-mail:
| | | | - Michael McDonald
- Department of Orthopedic Surgery, Henry Ford Macomb Hospital, Clinton Township, MI, USA
| | - Jay Patel
- Department of Orthopedic Surgery, University of New England College of Osteopathic Medicine, Biddeford, ME, USA
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22
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A rare cause of lateral ankle pain: A symptomatic talus secundarius. Foot Ankle Surg 2017; 23:e20-e24. [PMID: 29202998 DOI: 10.1016/j.fas.2017.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 02/04/2023]
Abstract
The talus secundarius is one of the rarest accessory tarsal bones, being present in 0.01% of all ankles. It is located at the lateral side of the talus, distally to the tip of the fibula. Hitherto, only five cases of a symptomatic talus secundarius have been described in literature. We presented a case of bilateral symptomatic talus secundarius in a young gymnast. There was a difference in size of the two accessory bones. The large talus secundarius in the left ankle was fixated, in the right ankle the fragment was excised. Both excision and fixation in the presented patient led to satisfactory results, both in the short and long term outcome.
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23
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J R B, Ma A, W K, A OG. The Diagnosis, Management and Complications Associated with Fractures of the Talus. Open Orthop J 2017; 11:460-466. [PMID: 28694883 PMCID: PMC5481613 DOI: 10.2174/1874325001711010460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/24/2017] [Accepted: 04/16/2017] [Indexed: 11/22/2022] Open
Abstract
Fractures of the talus are uncommon injuries that can have devastating consequences. The blood supply to the talus is tenuous and injuries are associated with a higher incidence of avascular necrosis and malunion. Talar neck fractures are the most common fractures. This review looks at the different types of fractures of the talus, particularly focusing on talar neck fractures. The diagnosis and management are discussed as well as the complications.
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Affiliation(s)
- Barnett J R
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Ahmad Ma
- Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - Khan W
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - O' Gorman A
- Department of Trauma and Orthopaedics, The Whittington Hospital, Magdala Ave, London, N19 5NF, UK
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Jentzsch T, Hasler A, Renner N, Peterhans M, Sutter R, Espinosa N, Wirth SH. The V sign in lateral talar process fractures: an experimental study using a foot and ankle model. BMC Musculoskelet Disord 2017; 18:284. [PMID: 28673281 PMCID: PMC5496392 DOI: 10.1186/s12891-017-1642-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/27/2017] [Indexed: 11/29/2022] Open
Abstract
Background Lateral talar process fractures (LTPF) are often missed on conventional radiographs. A positive V sign is an interruption of the contour of the LTP. It has been suggested, but not proven to be pathognomonic for LTPF. The objective was to study whether the V sign is pathognomonic for LTPF and if it can be properly assessed in different ankle positions and varying fracture types. Methods An experimental study was conducted. Two investigators assessed lateral radiographs (n = 108) of a foot and ankle model. The exposure variables were different ankle positions and fracture types. The primary outcome was the correct detection of a V sign. The secondary outcomes were the detection of the V sign depending on ankle position and fracture type as well as the uncertainty. Results The interobserver agreement on the V sign and type of fracture were fair (κ = 0.35, 95% CI 0.18–0.53, p < 0.001 and κ = 0.37, 95% CI 0.26–0.48, p < 0.001). The mean sensitivity, specificity, PPV, NPV, and likelihood ratio for the detection of the V sign were 77% (95% CI 67–86%), 59% (95% CI 39–78%), 85% (95% CI 75–92%), 46% (95% CI 29–63%), and 2. The mean uncertainty in the V sign detection was 38%. The V sign identification stratified by ankle position and fracture type showed significant better results with increasing inversion (p = 0.035 and p = 0.011) and type B fractures (p = 0.001 and p = 0.013). Conclusions The V sign may not be pathognomonic and is not recommended as the only modality for the detection of LTPF. It is better visualized with inversion, but does not depend on plantar flexion or internal rotation. It is also better seen in type B fractures. It is difficult to detect and investigator-dependent. It may be helpful in a clinical setting to point into a direction, but a CT scan may be used if in doubt about a LTPF.
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Affiliation(s)
- Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Niklas Renner
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Manuel Peterhans
- Department of Orthopaedics, Kantonsspital Aarau, Aarau, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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25
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Fracture of the Lateral Process of the Talus in Children: A Kind of Ankle Injury With Frequently Missed Diagnosis. J Pediatr Orthop 2016; 36:289-93. [PMID: 25785595 DOI: 10.1097/bpo.0000000000000437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the clinical characteristics, the treatment, and the outcome of lateral process fracture of the talus in children. METHODS From March 2011 to October 2013, 12 children with lateral process fracture of the talus were treated in our hospital. The study contained 3 female and 9 male patients, including 8 patients affected on the left side and 4 on the right side. The age at the time of injury ranged from 8 to 13 years. Concomitant injuries included undisplaced calcaneus fractures in 1 case and distal fibula epiphysis injury in 1 case. The patients presented to our hospital from 2 hours to 2 months after injury. All cases were classified by the Hawkins fracture system. Treatment included immobilization and not bearing weight for 4 weeks for nondisplaced fractures or open reduction and fixation for significantly displaced fractures. Therapeutic effects were evaluated on the basis of the AOFAS (The American Orthopaedic Foot and Ankle Society) Ankle Hindfoot Scale. RESULTS Seven of the cases were initially diagnosed in our department, and the diagnosis was missed in 5 cases. The missed diagnosis rate was 42%. All patients were followed up for 18 months on an average. Follow-up radiographs did not show avascular necrosis of the talus, nonunion, and malunion in any patient. The mean AOFAS hindfoot score was 96 points. The clinical result was found to be excellent in 10 patients, good in 1 patient, and fair in 1 patient (the success rate was 92%). CONCLUSIONS The lateral process of talus fracture is a frequently missed injury. The diagnosis must rely on thorough check-ups combined with standard radiographs and computed tomographic scan. Depending on the type and the displacement of the fracture, proper treatment options could be implemented for desirable clinical effects.
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26
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Abstract
This review article provides an overview of talus fractures. Special attention is given to the clinical literature that evaluates the timing of surgical management for displaced talus fractures. Several series support delayed definitive fixation for talus fractures, suggesting displaced fractures do not necessitate emergent surgical fixation.
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Affiliation(s)
- Benjamin J Grear
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN, USA.
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27
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Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB. Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification. Radiographics 2016; 35:765-79. [PMID: 25969933 DOI: 10.1148/rg.2015140156] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. Although talar fractures account for less than 1% of all fractures, they commonly result from high-energy trauma and may lead to complications and long-term morbidity if not recognized and managed appropriately. While initial evaluation is with foot and ankle radiographs, computed tomography (CT) is often performed to evaluate the extent of the fracture, displacement, comminution, intra-articular extension, and associated injuries. Talar fractures are divided by anatomic region: head, neck, and body. Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. The modified Hawkins-Canale classification of talar neck fractures is most commonly used due to its simplicity, usefulness in guiding treatment, and prognostic value, as it correlates associated malalignment with risk of subsequent osteonecrosis. Isolated talar body fractures may be more common than previously thought. The Sneppen classification further divides talar body fractures into osteochondral talar dome, lateral and posterior process, and shear and crush comminuted central body fractures. Crush comminuted central body fractures carry a poor prognosis due to nonanatomic reduction, bone loss, and subsequent osteonecrosis. Lateral process fractures can be radiographically occult and require a higher index of suspicion for successful diagnosis. Subtalar dislocations are often accompanied by fractures, necessitating postreduction CT. Familiarity with the unique talar anatomy and injury patterns is essential for radiologists to facilitate appropriate and timely management.
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Affiliation(s)
- Yulia Melenevsky
- From the Department of Radiology and Imaging, Georgia Regents University, 1120 15th St, Room BA-1414, Augusta, GA 30912
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28
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Abstract
UNLABELLED Talus fractures occur rarely but are often associated with complications and functional limitations. Urgent reduction of associated dislocations is recommended with open reduction and internal fixation of displaced fractures when adjacent soft tissue injury permits. Delayed definitive fixation may reduce the risks of wound complications and infections. Restoration of articular and axial alignment is necessary to optimize ankle and hindfoot function. Despite this, posttraumatic arthrosis occurs frequently after talar neck and body fractures, especially with comminution of the talar body. Osteonecrosis is reported in up to half of talar neck fractures, although many of these injuries will revascularize without collapse of the talar dome. Initial fracture displacement and presence of open fractures increase the risk of osteonecrosis. Talar process fractures may be subtle and easily missed on plain radiographs. Advanced imaging will provide detail to facilitate treatment planning. LEVEL OF EVIDENCE Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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29
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Wang PH, Su WR, Jou IM. Lateral Hindfoot Impingement After Nonunion of Fracture of the Lateral Process of the Talus. J Foot Ankle Surg 2015; 55:387-90. [PMID: 25998474 DOI: 10.1053/j.jfas.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Ping-Hui Wang
- Orthopedic Surgeon, Department of Orthopedics, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Wei-Ren Su
- Orthopedic Surgeon, Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Professor, Department of Orthopedics, National Cheng Kung University College of Medicine, Tainan, Taiwan
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30
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Funasaki H, Hayashi H, Sugiyama H, Marumo K. Arthroscopic reduction and internal fixation for fracture of the lateral process of the talus. Arthrosc Tech 2015; 4:e81-6. [PMID: 25973380 PMCID: PMC4427645 DOI: 10.1016/j.eats.2014.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/07/2014] [Indexed: 02/03/2023] Open
Abstract
Fractures of the lateral process of the talus (LPT) are relatively rare. We describe arthroscopic reduction and internal fixation for a type I fracture of the LPT according to the Hawkins classification. Preoperative computed tomography is necessary to evaluate the type and displacement of the LPT fracture because this type of fracture is often overlooked on a plain radiograph. The ankle is approached through a standard medial portal as the working portal and an anterolateral portal as the viewing portal. A 2.7-mm-diameter 30° arthroscope is used. Hematoma and soft tissues around the talus are cleared with a motorized shaver, and the anterior and lateral aspects of the talar process are visualized. Fracture reduction is obtained by pushing the lateral fragment of the lateral process medially and is fixed temporally with a 1.1-mm guidewire from the medial portal under both arthroscopy and fluoroscopy. A headless compression screw is inserted through the guidewire. Arthroscopic reduction and internal fixation for a type I LPT fracture can be easily accomplished, and return to daily and sports activities can be achieved in a relatively short time.
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Affiliation(s)
- Hiroki Funasaki
- Address correspondence to Hiroki Funasaki, M.D., Department of Sports and Wellness Clinic, Jikei University School of Medicine, 3-25-8 Nishishinbashi Minato-ku, Tokyo 105-8461, Japan.
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31
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Abstract
In this case study we report a fracture of the lateral process of the talus (LPF) in a snowboarder. The fracture is frequently overlooked initially, due to subtle clinical and radiological findings and a low incidence rate. However, LPF are associated with significant morbidity when missed. To address this, we report one case of a patient with a LPF and provide a review of the available literature.
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Affiliation(s)
- Irene Fleur Kramer
- Department of Trauma Surgery, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Lars Brouwers
- Department of Surgery, St. Elisabeth Hospital Tilburg, Tilburg, The Netherlands
| | - Peter R G Brink
- Department of Trauma Surgery, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Centre +, Maastricht, The Netherlands
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32
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Funasaki H, Kato S, Hayashi H, Marumo K. Arthroscopic excision of bone fragments in a neglected fracture of the lateral process of the talus in a junior soccer player. Arthrosc Tech 2014; 3:e331-4. [PMID: 25126497 PMCID: PMC4129989 DOI: 10.1016/j.eats.2014.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/13/2014] [Indexed: 02/03/2023] Open
Abstract
Fractures of the lateral process of the talus are uncommon and often overlooked. Typically, they are found in adult snowboarders. We report the case of an 11-year-old male soccer player who complained of lateral ankle pain after an inversion injury 6 months earlier. He did not respond to conservative treatment and thus underwent arthroscopic excision of fragments of the talar lateral process. The ankle was approached through standard medial and anterolateral portals. A 2.7-mm-diameter 30° arthroscope was used. Soft tissues around the talus were cleared with a motorized shaver, and the lateral aspect of the talar process was then visualized. The lateral process presented as an osseous overgrowth, and a loose body was impinged between the talus and the calcaneus. The osseous overgrowth was resected piece by piece with a punch, and the loose body was removed en block. The patient returned to soccer 5 weeks after the operation. This case exemplifies 2 important points: (1) This type of fracture can develop even in children and not only in snowboarders. (2) Arthroscopic excision of talar lateral process fragments can be accomplished easily, and return to sports can be achieved in a relatively short time.
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Affiliation(s)
- Hiroki Funasaki
- Address correspondence to Hiroki Funasaki, M.D., Department of Sports and Wellness Clinic, Jikei University School of Medicine, 3-25-8 Nishishinbashi Minato-ku, Tokyo 105-8461, Japan.
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33
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Lunebourg A, Zermatten P. Fracture of the lateral process of the talus: a report of two cases. J Foot Ankle Surg 2014; 53:316-9. [PMID: 24618244 DOI: 10.1053/j.jfas.2014.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Indexed: 02/03/2023]
Abstract
Fracture of the lateral process of the talus is a rare lesion commonly described in snowboarding injuries. Nevertheless, several conditions can lead to this injury, which is often misdiagnosed as a severe ankle sprain because of the difficulty in detecting it on standard radiographic views. Computed tomography is very helpful for the assessment of this injury. The type of treatment will depend on the size and degree of the displacement of the fracture. This injury can also lead to subtalar joint osteoarthritis. We report 2 cases of fracture of the lateral process of the talus. In the first case, a young male sustained a combined inversion and dorsiflexion strain of his right foot when he fell from a ladder. In the second case, a woman broke the lateral process of her right talus by the same mechanism when she was sledding. In the 2 situations, we opted for an open reduction and internal fixation using 2.4-mm cannulated screws. Both patients were allowed walking with partial weightbearing with a walker boot (VACOped(®)) for 6 weeks. At 1 year, both showed a consolidated fracture and had regained their preinjury level of activity.
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Affiliation(s)
- Alexandre Lunebourg
- Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland
| | - Philippe Zermatten
- Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, Sion, Switzerland.
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34
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Gómez Robledo J. Associated lateral process and posteromedial tubercle talus fractures with entrapment of the medial neurovascular bundle: a case report. Foot (Edinb) 2013; 23:149-53. [PMID: 23953974 DOI: 10.1016/j.foot.2013.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/27/2012] [Accepted: 07/17/2013] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Jaime Gómez Robledo
- Department of Traumatology and Orthopaedic Surgery, Sierrallana Hospital, 39300 Torrelavega, Spain.
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Abstract
This article discusses the role of ankle arthroscopy in the acute management of ankle trauma in athletes. The rate of intra-articular pathology associated with ankle trauma is high and arthroscopic treatment often has an important role to play. Its major role is in the assessment and treatment of joint surface damage, syndesmotic instability, and intra-articular fractures.
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Affiliation(s)
- Steve Hepple
- Department of Orthopaedics, Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
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Affiliation(s)
- Alan Y Yan
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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