Image Quiz: Lateral Process Fracture of the Talus

Background: Lateral talar process fractures and peroneal tendon dislocations are frequently unrecognized at the time of injury. Lateral process fractures were initially classified by Hawkins as three types. Type II injuries are comminuted fractures involving both the talofibular and talocalcaneal articular surfaces. The purpose of this retrospective chart review was to describe an injury complex of Type II lateral talar process fracture with peroneal tendon dislocation. Materials and Methods: Between January of 1995 and December 2006, 13 patients were seen for a lateral talar process fracture. Patients' charts were reviewed for fracture classification, mechanism of injury, radiographic studies, treatment, secondary procedures, length of followup and return to previous activity level. Concurrent peroneal tendon dislocations were identified in a subset of these patients. Results: Thirteen patients were identified with lateral talar process fractures all of which were classified as a Hawkins Type II. Six patients (46%) had a simultaneous peroneal tendon dislocation. All patients underwent operative excision of the comminuted lateral process. Patients with the injury complex were more likely to undergo additional operative procedures, and were more likely to develop subtalar arthritis. At final followup, 71% of patients with isolated lateral process fractures and 33% of injury complex patients had returned to their previous level of activity Conclusion: An injury complex of Hawkins Type II lateral talar process fractures and peroneal tendon dislocation exists. Patients with comminuted lateral talar process fractures, especially those resulting from high-energy injuries, should be carefully evaluated for the possibility of concurrent peroneal tendon dislocation. Level of Evidence: IV, Retrospective Case Study

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

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2011.46.3.262 ◽

2011 ◽

Vol 46 (3) ◽

pp. 262

Author(s):

Kyoung-Jin Park ◽

Byung-Ki Cho ◽

Yong-Min Kim ◽

Dong-Soo Kim ◽

Eui-Sung Choi ◽

...

Keyword(s):

Lateral Process

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Fractures of the Lateral Process of the Talus: A New Classification Based on CT

10.21203/rs.3.rs-138940/v1 ◽

2021 ◽

Author(s):

Yuchuan Wang ◽

Yanbin Zhu ◽

Xiangtian Deng ◽

Zhongzheng Wang ◽

Siyu Tian ◽

...

Keyword(s):

Classification System ◽

Intraobserver Reliability ◽

Kappa Statistics ◽

Type I ◽

New Classification ◽

Concomitant Injuries ◽

Term Outcome ◽

Long Term Outcome ◽

Lateral Process ◽

Comprehensive Classification

Abstract Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.

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Arthroscopic Excision of Bone Fragments in a Neglected Fracture of the Lateral Process of the Talus in a Junior Soccer Player

Arthroscopy Techniques ◽

10.1016/j.eats.2014.01.014 ◽

2014 ◽

Vol 3 (3) ◽

pp. e331-e334 ◽

Cited By ~ 6

Author(s):

Hiroki Funasaki ◽

Soki Kato ◽

Hiroteru Hayashi ◽

Keishi Marumo

Keyword(s):

Soccer Player ◽

Lateral Process ◽

Arthroscopic Excision ◽

Bone Fragments

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The Snowboarder's Foot and Ankle

The American Journal of Sports Medicine ◽

10.1177/03635465980260021901 ◽

1998 ◽

Vol 26 (2) ◽

pp. 271-277 ◽

Cited By ~ 136

Author(s):

Douglas P. Kirkpatrick ◽

Robert E. Hunter ◽

Peter C. Janes ◽

Jackie Mastrangelo ◽

Richard A. Nicholas

Keyword(s):

Injury Rate ◽

Soft Tissue Injuries ◽

Fracture Pattern ◽

Ankle Injuries ◽

Anterior Talofibular Ligament ◽

Ankle Sprains ◽

Foot And Ankle ◽

Foot Injuries ◽

Lateral Process ◽

Ski Resorts

We undertook a prospective study to determine the type and distribution of foot and ankle snowboarding injuries. Reports of 3213 snowboarding injuries were collected from 12 Colorado ski resorts between 1988 and 1995. Of these, 491 (15.3%) were ankle injuries and 58 (1.8%) were foot injuries. Ankle injuries included 216 (44%) fractures and 255 (52%) sprains. Thirty-three (57%) of the foot injuries were fractures and 16 (28%) were sprains. The remaining injuries were soft tissue injuries, contusions, or abrasions. There was no significant correlation between boot type (soft, hybrid, or hard) and overall foot or ankle injury rate. There were significantly fewer ankle sprains in patients wearing hybrid boots and fewer fractures of the lateral process of the talus in patients wearing soft boots. An unexpectedly high number of fractures of the lateral process of the talus were noted. These 74 fractures represented 2.3% of all snowboarding injuries, 15% of all ankle injuries, and 34% of the ankle fractures. Many of these fractures are not visible on plain radiographs and require computed tomography imaging to be diagnosed. Diagnosis of this fracture pattern is paramount; the physician should be very suspicious of anterolateral ankle pain in the snowboarder, where subtle fractures that may require surgical intervention can be confused with anterior talofibular ligament sprains.

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MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00355 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0035

Author(s):

Hiroyuki Mitsui ◽

Takaaki Hirano ◽

Hisateru Niki

Keyword(s):

Clinical Symptoms ◽

Predictive Tool ◽

Ankle Osteoarthritis ◽

Talocrural Joint ◽

Radiographic Findings ◽

Lateral Process ◽

Metatarsal Angle ◽

Magnetic Resonance Imaging Mri ◽

The Relationship ◽

Surface Angle

Category: Ankle Arthritis Introduction/Purpose: We have previously studied the relationship between Takakura–Tanaka classification stages and bone-marrow edema (BME) in order to elucidate the pathology of ankle osteoarthritis (ankle OA) on magnetic resonance imaging (MRI). Moreover, we have investigated that BME onset on the talocrural joint can be predicted according to radiographic findings. In the present study, we focused on the changes around the subtalar joint to examine the relationship between talar lateral process impingement (TLPI) and foot and ankle joint alignment, and whether TLPI can be predicted on the basis of X-ray findings. Methods: We assessed 30 feet of 30 patients who had a diagnosis of ankle OA in our hospital and underwent MRI. Alignment was assessed radiographically by measuring the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), the lateral talo-first metatarsal angle (LTMT), the lateral talocalcaneal angle (LTC), and the tibial axis–talar ratio (T-T ratio). MRI was obtained with the talocrural, subtalar and Chopart joints into 22 subdivided areas to examine the frequency of BME for each patient. TLPI was considered positive (+) when BME was found in the talar lateral process. The patients were divided into two groups according to TLPI positivity or negativity. Their BME frequency was examined, and significant differences in radiographically measured values were analysed with a t-test. Results: In the TLPI (+) group, BME development occurred at significantly higher frequencies in all areas except those surrounding the lateral process (p = 0.002). In addition, TLS was significantly lower (p = 0.02), and LTMT was significantly higher (p = 0.04). When the cut-off value on the ROC curve was set at TLS of =74° and LTMT of =19°, TLPI onset could be predicted with a sensitivity of 75% and a specificity of 71%. Conclusion: Our results revealed that in the TLPI (+) group, progression of the anteriorly opened talocrural joint and talar dorsiflexion may be causing the talar lateral process to hit the calcaneus. Furthermore, in the TLPI (+) group, BME in other areas also occurred at higher frequencies, and symptoms around the ankle joints may be occurring at multiple locations. The fact that TLPI could be predicted from radiography findings suggests that this may be a potential predictive tool of the severity of clinical symptoms.

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