Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years

Winning, Dominik von; Lippisch, Roland; Pliske, Gerald; Adolf, Daniela; Walcher, Felix; Piatek, Stefan

doi:10.1016/j.fas.2018.11.013

Cited by 8 publications

(18 citation statements)

References 37 publications

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“…7 Posterior process and talar body fractures are a challenging, poorly understood subset of talus injuries that have generated less research interest than the more commonly occurring fractures of the talar neck. 5,16,28,33 Often they are missed on initial radiographic evaluation. 22,33 However, as computed tomography (CT) has become far more widely used recently, published incidence rates of peripheral process fractures have increased, with the most recent estimate suggesting that the posterior process or posterior body is involved in 21% of all talus fractures.…”

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confidence: 99%

“…5,16,28,33 Often they are missed on initial radiographic evaluation. 22,33 However, as computed tomography (CT) has become far more widely used recently, published incidence rates of peripheral process fractures have increased, with the most recent estimate suggesting that the posterior process or posterior body is involved in 21% of all talus fractures. 8 Inadequate treatment of posterior process fractures is associated with high morbidity as these injuries can affect both the tibiotalar and subtalar articulations.…”

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confidence: 99%

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Talar Dome Access Through Posteromedial Surgical Intervals for Fracture Care

et al. 2021

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Background: Posterior talar body fractures are rare injuries without a consensus surgical approach. This study evaluates the accessible area of the talar dome through 2 posteromedial approach intervals (posteromedial [PM] and modified posteromedial [mPM]) both with and without distraction. Methods: Ten male cadaveric legs (5 matched pairs) were included. A PM approach, between flexor hallucis longus (FHL) and the tibial neurovascular bundle, and an mPM approach, between FHL and Achilles tendon, was performed on each pair. In total, 4 mm of distraction across the tibiotalar joint was applied with the foot held in neutral position. Accessible dome surface area (DSA) was outlined by drilling with a 1.6-mm Kirschner wire with and without distraction. Specimens were explanted and analyzed by micro–computed tomography with 3-dimensional reconstruction. Primary outcomes were total accessible DSA and sagittal plane access at predetermined intervals. Results: The PM approach allowed access to 19.1% of the talar DSA without distraction and 33.1% of the talar dome with distraction ( P < .001). The mPM approach provided access to 20.4% and 35.6% of the talar DSA without and with distraction ( P < .001). Both approaches demonstrated similar sagittal plane access at all intervals except the lateral border of the talus, where the mPM approach provided greater access both without distraction (20.5% vs 4.38%, P = .002) and with distraction (34.3% vs 17.8%, P = .02). Conclusion: The mPM approach, using an interval between FHL and Achilles tendon, provides similar access to the posterior surface of talar dome and better sagittal plane access to the most lateral portion of the dome. The mPM interval provides the advantage of avoiding direct dissection of the tibial nerve or posterior tibial artery. Using an external fixator for distraction can improve talar dome visualization substantially. Level of Evidence: Level V, Cadaveric Study.

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Talar Dome Access Through Posteromedial Surgical Intervals for Fracture Care

et al. 2021

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“…There are only a few reports about cases of entire posterior process fractures, according to previous literatures 6,18 . To the author's knowledge, there are few descriptions of surgical techniques for fractures of posterior talar process in the literature 8,13,19 . Some studies reported different types of posterior process fractures, however, none of them defined an optimized approach and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…ORIF for extensive posterior talar fractures has been reported to provide good functional outcome, quality of life and patient satisfaction 11 . Therefore, this technique is the most common treatment described in previous literature [12][13][14] .…”

Section: Initial Assessment Of Treatment Of Talar Posterior Process Fmentioning

confidence: 99%

“…Pain score and function were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. The AOFAS scores were categorized as excellent (90-100 points), good (80-89points), fair (70-79 points), and poor (69 points) 13 . It should be noted, that the AOFAS score is currently not validated for most authors in the literature.…”

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confidence: 99%

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

Mao

Wang

Zhao

et al. 2020

Sci Rep

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The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.

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Patient-Reported Outcomes After Lateral Process Talus Fracture

Ross

Marchand

Cardon

et al. 2021

Journal of Orthopaedic Trauma

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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 28.3), FAAM Activities of Daily Living (ADL) was 89 (SD 214), and FAAM sport was 77 (SD 220). The patients treated with operative fixation had significantly larger fracture fragments (2050 vs. 1066 mm 3 , 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.

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Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years

Cited by 8 publications

References 37 publications

Talar Dome Access Through Posteromedial Surgical Intervals for Fracture Care

Talar Dome Access Through Posteromedial Surgical Intervals for Fracture Care

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

Patient-Reported Outcomes After Lateral Process Talus Fracture

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