Talus Fracture - Lateral Process S92.199A 825.21

 
ICD-10 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms: Snowboarder's fracture, Skateboarder's fracture

 Talus-Lateral Process Fracture ICD-10

Talus-Lateral Process Fracture Etiology / Epidemiology / Natural History

  • Associated with snowboarding
  • Masquerades as an anterolateral ankle sprain
  • Reportedly occurs in 20% to 30% of patients who sustain foot and ankle injuries while snowboarding.  (McCrory P, Clin J Sport Med 1996;6:124).
  • Can be experimentally produced by everting an axially loaded, dorsiflexed ankle. (Funk JR, AJSM 2003;31:921).

Talus-Lateral Process Fracture Anatomy

  • The artery of the tarsal canal(posterior tibial artery) is the main blood supply to the body of the talus.  It forms an anastomotic sling with the artery of the tarsal sinus (peroneal).  Others=superior neck vessels from anterior tibial artery, Deltoid artery(post tibial)(Mulfinger JBJS 52B:160 1970
  • 60% covered with articular cartilage, no muscle originate from or insert into talus.
  • Lateral process: a wide, wedge-shaped prominence extending from the lateral aspect of the body of the talus; consists of two distinct articular facets: the dorsolateral and the inferomedial. The dorsolateral facet articulates with the distal fibula; the inferomedial facet forms the anterolateral portion of the subtalar joint. The lateral process is the site of insertion of the lateral talocalcaneal ligament.
  • Posterior process: composed of a medial and a lateral tubercle(Stieda’s process) which are separated by a groove within which lies the flexor hallucis longus tendon. The Y-shaped, bifurcate talocalcaneal ligament forms a roof over this grooveand inserts onto each tubercle. The posterior talofibular ligament inserts onto the lateral tubercle of the talus. The posterior talotibial portion of the deltoid ligament inserts onto the medial tubercle.
  • Os trigonum: located directly posterior to the lateral tubercle(Stieda's process). It is an accessory bone that arises from a secondary ossification center between the ages of 8 and 11 years. Generally fuses to the lateral tubercle within 1 year of its appearance. May persist as a separate ossicle, attached to the talus by a cartilaginous synchondrosis. (Grogan DP, JPO 1990;10:618)

Talus-Lateral Process Fracture Clinical Evaluation

  • Persistent tenderness just anterior and inferior to the lateral malleolus in a patient previous diagnosed with an ankle sprain.

Talus-Lateral Process Fracture Xray /Diagnostic Tests

  • A/P, Lateral, and Mortise Ankle and A/P, Oblique, Lateralfoot xrays indicated. Difficult to detect on standard xrays
  • Best seen on a mortise view with a fragment just distal to the lateral malleolus, particularly with the foot in internal rotation.
  • Bladin recommends that lateral xray be taken with the ankle in DF and IN position. 
  • CT-scan is the imaging technique of choice and is highly sensitive (Noble J, Br J Sports Med 1992;26:245). 

Talus-Lateral Process Fracture Classification/Treatment

  • Acute Non-displaced (<1cm in size or <2mm displaced):short-leg, non-weight bearing cast for 6 weeks. Advance to wbat in removable cam-walker if asymptomatic at 6weeks. (Funk JR, AJSM 2003;31:921).
  • Noncomminuted, Displaced (>1cm in size or >2mm displaced): ORIF with small or mini-fragment screws or k-wires. Approach via an incision over the tarsal sinus, with distal reflection of the extensor digitorum brevis muscle. (Valderrabano V, AJSM 2005;33:871).
  • Comminuted, Displaced: Primary excision
  • Chronic injuries generally have poor outcomes with non-surgical management and fragment excision for small non-articular fragments or ORIF for large articular fragments should be consider.

Talus-Lateral Process Fracture Associated Injuries / Differential Diagnosis

  • Talar Body fracture
  • Fracture-dislocation of the subtalar joint
  • Fracture-dislocation of the ankle
  • Ankle fracture
  • Metatarsal fracture
  • Ankle Sprain

Talus-Lateral Process Fracture Complications

  • Malunion
  • Nonuion
  • Chronic pain
  • Inability to return to sport

Talus-Lateral Process Fracture Follow up  care

Talus-Lateral Process Fracture Review References

  • Rockwood and Greens
  • Boon AJ: Snowboarder's talus fracture:  Mechanism of injury.  Am J Sports Med 2001;29:333-338.
  • Bladin C:  Australian snowboard injury database study: A four year prospective study.  Am J Sports Med 1993;21:701-704.