Significance of Lateral Process Fractures Associated With Talar Neck and Body Fractures

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.

Initial assessment of treatment of talar posterior process fractures with open reduction and percutaneous fixation

“…Closed reduction of the subtalar dislocation was performed initially in this study. A CT scan is recommended in order to reveal the fracture type and assess the displacement of the fracture fragment 12,29 . A minimally invasive approach, which minimized the intraoperative risk of lesion of neurovascular structures, was described and preoperative individual planning with computer-assisted three-dimensional techniques for positioned percutaneous screws was recommended.…”

Talus Fractures: An Update on Current Concepts in Surgical Management

“…Lateral process fractures have been associated with snowboarding injuries and are best seen on an ankle mortise or internal oblique view. 6 Advanced imaging with a CT scan can help visualize the fracture in detail and better assess for displacement. Posterior process fractures are best seen on a lateral view.…”

“…A modified sinus tarsi approach can be used for isolated fractures of the lateral process. 6,9 When associated with a talar neck fracture, the dorsolateral approach is modified such that the proximal start point of the incision is just off the tip of the fibula rather than directly in line with the fourth ray. Reduction is achieved by manipulation of fragments with dental picks and disimpaction of the subtalar articular surface with Freer elevators.…”

“…16,24,28 Talar neck and body fractures with associated lateral process fractures and comminution of the inferior articular surface are also at increased risk of developing subtalar arthritis. 6 The development of posttraumatic arthritis has been associated with worse patient-reported outcome scores. 31 Symptomatic posttraumatic arthritis may be treated conservatively with bracing and medication or with arthrodesis of the tibiotalar or subtalar joints.…”

“…16,24,28 Talar neck and body fractures with associated lateral process fractures and comminution of the inferior articular surface are also at increased risk of developing subtalar arthritis. 6 The development of posttraumatic arthritis has been associated with worse patient-reported outcome scores. 31…”