Fracture of the posterior body of the talus ? the hidden fracture

Abstract

Fractures of the entire posterior process of the talus are rare and may be easily missed. Both the ankle joint and the subtalar joint are involved. This leads to malunion and early degenerative changes. We describe four patients with fractures of the posterior process of the talus which were initially missed. The patients were treated conservatively, and early mobilization or cast immobilization did not change the poor late results. The pitfalls in the diagnosis and imaging evaluation of such fractures are discussed.

Fracture of the Posterior Process of Talus with Pilon Fracture: A case report

“…4,11 Failure to diagnose undisplaced fracture can cause painful non-union and significant disability. 2,4,12 The commonest fracture in the posterior aspect of the talus is fracture of the lateral tubercle. Lateral tubercle fractures are often missed and misdiagnosed as ankle sprains.…”

“…Lateral tubercle fractures are often missed and misdiagnosed as ankle sprains. 12 Posteromedial approach, 9 after mobilization of the neurovascular bundle is used by most of the authors. This fracture can be approached either through a posterolateral or posteromedial approach.…”

“…7 Excision of the posterior part of the talus is suggested by Nyska in late diagnosed cases, though there are no published reports. 12 Concomitant fractures are not reported 6,7 , and to the author's knowledge the only report is that of medial malleolus and posterior process fracture by Bhanot, et al,. 1 Naranja, et al, reported on a case of open medial subtalar dislocation in association with fracture of posterior process of the talus.…”

Talus fractures: assessment and treatment

“…[18] Hastaların büyük bölümü çoklu yaralanmalı veya çoklu kırıkları olan hastalardır. [19] Talusun arka-iç ve lateral çıkıntı kırıkları özellikle spor yaralanmalarında sıkça görülen inversion-eversion gibi düşük enerjili yaralanmalar ile de meydana gelebilmektedir.…”

“…[2] Çoklu travmalı hastalarda talus kırığını atlamamak için hastanın muayenesinde dikkatli olunmalıdır. [18] Özellikle direkt radyografiler ile değerlendirilmesi zor olan talus çıkıntı kırıklarından şüphe ediliyor ise ileri görüntüleme tekniklerine geçilmelidir. [20] Talus kırıkları oluş mekanizması ne olursa olsun süratle tedavi edilmezlerse tüm olgularda kalıcı sekellere yol açabilir.…”