CAS Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. Fracture of the entire posterior process of the talus: a case report. Today on the Doc On The Run Podcast were talking about posterior process fractures of the talus. Moreover, there is little consensus on how best to stabilize the fracture once it has been reset. 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. Arch. Initial assessment of short-term results in patients who underwent internal fixation using ORIF and percutaneous screw techniques for posterior talar process fracture was performed in this study. Most reports of talar posterior process fractures are associated with subtalar dislocation7,8,9 and the recommended treatment is early open reduction and internal fixation (ORIF) or percutaneous screw fixation8. To evaluate the surgical outcomes of talar, posterior process displaced fractures with posteromedial approach. But if you have chronic pain, if you think you have posterior ankle pain where you might have problems with your posterior process, or you think maybe you sprained your ankle and maybe somethings broken and got missed, join us for the masterclass, the web class that we do on ankle pain in runners, and I think youll learn a lot about some of the things you can check all on your own, and some other questions you can ask your doctor so that you can make sure that you can get that better and get back to running as quickly as possible. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. In general, these injuries are described as tibial plafond fractures (plafond referring the part of the tibia where joint articulation occurs). The average follow-up period was 13months (816months). Whats the significance of that? PubMedGoogle Scholar. Foot Ankle Surg. 2, 10, 11 Non weight-bearing and short leg casts are recommended for 4 to 6 weeks followed by 2 weeks of weight bearing to tolerance. The patient is a 27-year-old male with left talar neck fracture (Hawkins type-2) (a, b).The X-ray after closed reduction showed a good position (c, d).Percutaneous insertion of guide wires and screws from posterior to anterior were used along the guide wires for fixation (e, f).Hawkins sign was found at eight weeks post-operatively (g, h).The follow-up CT showed that the fracture was union . The yellow arrow is a cannulated screw. and JavaScript. Sports Med. Romeo, N. M., Hirschfeld, A. G., Githens, M., Benirschke, S. K. & Firoozabadi, R. Significance of lateral process fractures associated with talar neck and body fractures. https://doi.org/10.1177/1071100719868712 (2019). Foot Ankle 13, 453457 (1992). One or two screws were positioned for fixation of the medial and lateral tubercle of the posterior talar process (Fig. Talus fractures have a wide variety of presentation from low-energy avulsion fractures of the lateral or posterior processes, to high-energy comminuted talar body fractures. Read More. Get the most important science stories of the day, free in your inbox. A closed reduction and internal fixation of the posterior process of the talus using a minimally invasive approach was performed, based on the images from the preoperational simulations (Fig. Sci Rep 10, 20221 (2020). posterior process consist of medial and lateral tubercles separated by groove for FHL Navicular bone Sustenaculum tali Blood supply talar neck supplied by three sources posterior tibial artery via artery of tarsal canal (dominant supply) supplies majority of talar body deltoid branch of posterior tibial artery supplies medial portion of talar body Operative treatment of posterior malleolar fractures. Amoretti, N. & Huwart, L. Percutaneous screw fixation of a talar fracture under computed tomography and fluoroscopy guidance. Letonoff, E. J., Najarian, C. B. Traditionally, surgeons have long recommended surgery if more than 25% of the malleoli is involved. No patients complained of stiffness in the ankle and subtalar joint. Immediate first aid treatment for a talus fracture, as with any painful ankle injury, is to apply a well-padded splint around the back of the foot and leg to immobilize and protect the limb. 38.3, A and B shows preoperative and postoperative radiographs of a talar neck fracture, respectively. A., Okereke, E. & Williams, G. R. Jr. Open medial subtalar dislocation associated with fracture of the posterior process of the talus. Posterior Malleolus Fractures Posterior malleolus fractures can be challenging to an orthopedist since the fracture pattern is often irregular. Assoc. https://doi.org/10.1016/j.injury.2007.04.025 (2007). 19, 641646. This is due to attachments of ligaments between the two bones. Surgical treatment of lateral and posterior process fractures of the talus: Mid-term results of 15 cases after 7 years. Kopp L, Obruba P, Riegl J, Meluzinov P, Edelmann K. Acta Chir Orthop Traumatol Cech. If that happens and you have chronic pain, well, you need to address it. The skin and subcutaneous tissue were carefully dissected when close to the posterior tibial neurovascular bundle (Fig. This study provided insight into our previous experience using percutaneous screw fixation and ORIF techniques for the treatment of posterior talar process fracture with clinical outcome assessment. Exclusion criteria included surgeries on open posterior process fractures and additional procedures due to talar body and neck fractures. HHS Vulnerability Disclosure, Help Read our, Bimalleolar and Trimalleolar Ankle Fractures, Medial Malleolus Fracture and Broken Ankle Treatment, Physical Therapy Exercises After a Tibial Plateau Fracture, Common Fractures of the Leg, Ankle, and Foot, The Causes and Treatment of Foot and Ankle Stress Fractures, Posterior Tibial Tendonitis Signs and Treatment, Isolated posterior malleolus fracture: a rare injury mechanism, Operative treatment of posterior malleolar fractures, The isolated posterior malleolar fracture and syndesmotic instability: a case report and review of the literature, Addressing posterior malleolar ankle fractures, The posterior malleolus situated on the lower back side of the tibia. Foot Ankle Int. Careers. The https:// ensures that you are connecting to the New Zeal. The raw data were acquired in DICOM format and reconstructed into 3D models using the software MIMICS 15.01 (Materialise's interactive medical image control system, Leuven, Belgium, https://www.materialise.com/mis)15. Open Orthop J. However, it is apparent that . Isolated breaks are rare, and, when they do happen, they tend to be difficult to reduce (reset) and fixate (stabilize).. Complication rates were high, ranging between 6% SSI up to 64% osteoarthritis, following operative treatment of talar fractures. Elderly patients with limited ambulatory capacity, similarly, may be best treated nonoperatively if the joint is not significantly displaced Fracture of the posterior process of the talus is an uncommon injury that is often missed on plain X-Ray and misdiagnosed as ankle sprain. Fig. de Palma, L., Santucci, A., Marinelli, M., Borgogno, E. & Catalani, A. PMC 9 Hospital, Ningbo, Zhejiang, China, You can also search for this author in So sometimes a posterior process is an actual fracture, and sometimes it's a natural occurrence where the bone just hasn't fully ossified, and technically you have this other thing called an Os trigonum it doesn't really matter the specifics of the terms or what that means, it just means you have a natural separation of the two pieces . [Surgical management of talus fractures: mid-term functional and radiographic outcomes]. With that being said, there remains controversy as to when it is most appropriate. 2017 Feb;9(1):28-33. doi: 10.1111/os.12303. Ebraheim, N. A., Patil, V., Frisch, N. C. & Liu, X. In some cases, the bone will not need to be repositioned, and the fragment can be secured without surgery. This is a small canal where nerves pass . 2012 Apr;29(2):187-203, vii. J. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. Typically, surgeons will immobilize the ankle and allow the incisions to heal before initiating physical therapy. Even a minimal displacement of the fracture fragment may result in substantial joint misalignment and posttraumatic arthritis, posterior impingement and entrapment of the flexor hallucis longus tendon due to tibiotalar and talocalcaneal joints. This is why postoperative care will often require the ankle to be non-weight-bearing for six weeks. Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Update on talar fracture patterns: a large level I trauma center study. The injuries can be divided anatomically into osteochondral, lateral process, posterior process, and true body (dome) fractures. in posterior impingement is believed to be the result of bone impaction and thus represents bone contusions or occult fractures. The cause of injury for eight of the cases was vehicle accident and for four of the cases sport injury. The statistical significance of the difference between the groups was determined at the 0.05 significance level15. A bone fracture is the medical term for breaking a bone. Naranja, R. J. Jr., Monaghan, B. Mehrpour, S. R., Aghamirsalim, M. R., Sheshvan, M. K. & Sorbi, R. Entire posterior process talus fracture: a report of two cases. There is likely to be tenderness and possibly swelling over the sinus tarsi. Serbest S, Tiftiki U, Tosun HB, Kesgin E, Karata M. Isolated posterior malleolus fracture: a rare injury mechanism. Use the Previous and Next buttons to navigate three slides at a time, or the slide dot buttons at the end to jump three slides at a time. J. Type 4 talus fractures include not only the dislocation of the body of the talus (the posterior portion) from the calcaneus but also the separation of the head of the talus from the other tarsal bones anterior to it. Fracture of the posterior process involves both the ankle and the subtalar joints; thus, fracture malunion can lead to arthritis in both joints 2, 3, 4. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. Thus, adequate access to the fracture fragments and using lag screws for fixation is achieved and for the neurovascular bundle to remain unharmed. You may have to wear a cast or splint to prevent further damage. Jonathan Cluett, MD, is board-certified in orthopedic surgery. American Academy of Orthopaedic Surgeons. BMJ Case Rep. 2013, 16:2012007763. Acta Orthop. Because the ankle is vulnerable to twists and compression, the fracture of these bones is not uncommon and can sometimes be difficult to treat. The blue arrow is the flexor hallucis longus tendon. The clinical data was offered by K.W.. Shibuya et al (PMID: 24785202) found that open fractures occur in approximately 20% of calcaneus and talus fractures. 51, 326329. Symptoms of a stress fracture of the talus develop gradually over time and include: Pain on the outside of the ankle. Clinical and radiological outcomes of patients were assessed at 4 and 12months postoperatively. doi:https://doi.org/10.1177/0363546504271001 (2005). ISSN 2045-2322 (online). From January 2008 to December 2010, 18 patients with displaced fracture of talar poste. Most posterior malleolus fractures are associated with another injury, usually a fracture of the lateral malleolus. 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. The achieved position of each screw was verified using the 3D reconstructions and three different 2D images, taken in three different planes (axial, coronal and sagittal), thus enabling assessment of potential perforation into the subtalar or the ankle joint15. The main manuscript text was written by H.M. official website and that any information you provide is encrypted Early diagnosis and timely determination of the displacement of the fracture are necessary for the choice between the using of percutaneous screw or ORIF technique. 2020 Feb 11;15(1):45. doi: 10.1186/s13018-020-1560-8. Pain score and function were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) AnkleHindfoot score. Tucker, D. J., Feder, J. M. & Boylan, J. P. Fractures of the lateral process of the talus: two case reports and a comprehensive literature review. Thank you, {{form.email}}, for signing up. The posterior process of the talus originates from the convex-curved posterior half of the talar dome and slopes down and back to form the posterior talar "beak." Inferiorly, it is concave and articulates with the posterior subtalar facet of the calcaneus. 226230 (1994). Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. It forms a joint with the talus bone, the subtalar joint. Intraoperative photo of ORIF. The average follow-up period was 13months. ORIF for extensive posterior talar fractures has been reported to provide good functional outcome, quality of life and patient satisfaction11. Well that thing curves right down around the back of the ankle, and if you get a fracture or a crack in that part of the talus, when you roll your ankle really, really badly, well that can cause chronic pain, because what happens is that you get a little crack there, and every time you take a step, youve got the FHL tendon (flexor hallucis longus) going right around here and it wraps around as it goes down around the bottom of your foot, and every time you take a step and you pull down with the big toe, it actually pulls on the posterior process fracture and it moves it and that causes pain. If a fracture wassuspected with plain radiographs, then an urgent CT scan wasrecommended in order to identify the fracture and assess the size and fracture fragment. Generally speaking, the best way to reposition the bone is through an incision in the back of the ankle. Talus fractures have a wide variety of presentation from low-energy avulsion fractures of the lateral or posterior processes, to high-energy comminuted talar body fractures. Posterior talar process fractures may involve the medial or lateral tubercle of the posterior process of the talus. J. Pediatr. The postoperative course of the patients was evaluated based on Visual Analog Scale (VAS). Buddy Taping/6 weeks: Non displaced fracture is treated with Buddy Taping and rigit sole shoes to limit joint movements.Buddy taping is taping the fractured toe to the next. doi:https://doi.org/10.1016/j.fas.2018.11.013 (2018). Thus, talus fractures are relatively uncommon, comprising less than 1 percent of all fractures [ 1 ]. Excellent and good results were achieved in eight (66.7%) patients, fair results were achieved in three (25%), and poor results were observed (8.3%) for the last follow-up. Article Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. https://doi.org/10.1097/BOT.0b013e31804ea0d9 (2007). Surg. The posterior talofibular ligament attaches to the lateral tubercle and flexor hallucis longus runs between these two tubercles. - posterolateral ankle tenderness may be elicited; That ones longer, so its called the flexor hallucis longus tendon. You can break your talus in a trauma like a fall or car accident. Any fractures that exhibited displacement larger than 2mm involving joint surface were treated with percutaneous screw fixation or ORIF. Among a total of 12 patients have undergone pre and post-operative 3D-CT. Correlation factors for distal syndesmosis ossification following internal fixation of ankle fracture, A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures, Arthroscopy Assisted Reduction Percutaneous Internal Fixation versus Open Reduction Internal Fixation for Low Energy Tibia Plateau Fractures, A new surgical strategy for the treatment of tibial pilon fractures with MIPO facilitated by double reverse traction repositor, Application of the multiplanar fracture redactor in the treatment of tibial shaft fractures with intramedullary nails, Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study, The limitations of fully threaded screws in isolated percutaneous transarticular screw fixation of C1/C2, Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures, Low occupancy rate of the pedicle screw in the vertebral body leads to upper instrumented vertebral fracture, https://doi.org/10.1097/BOT.0b013e31804ea0d9, https://doi.org/10.1177/107110079601700408, https://doi.org/10.1016/j.injury.2014.12.002, https://doi.org/10.1097/BPB.0b013e328351419c, https://doi.org/10.1007/s00402-007-0459-8, https://doi.org/10.1302/2058-5241.3.170040, https://doi.org/10.1016/j.fas.2018.11.013, https://doi.org/10.1053/j.jfas.2016.02.001, https://doi.org/10.1097/MD.0000000000013331, https://doi.org/10.1177/107110079801900414, https://doi.org/10.1053/j.jfas.2012.02.007, https://doi.org/10.3109/08941939.2012.740146, https://doi.org/10.1016/j.injury.2007.04.025, https://doi.org/10.1111/j.1445-2197.1987.tb01441.x, https://doi.org/10.1177/107110079801900915, https://doi.org/10.1186/s12891-019-2603-3, https://doi.org/10.1097/00005131-199602000-00014, https://doi.org/10.1016/j.fas.2012.01.003, https://doi.org/10.1016/j.jvir.2012.09.006, https://doi.org/10.1097/BOT.0000000000001326, http://creativecommons.org/licenses/by/4.0/, Anatomical observation, classification, fracture and finite element analysis of the posterior process of the Asian adult talus. And sometimes patients are told that they have a posterior process fracture when they really dont. Excision of ununited fractures of the posterior process of the talus: a treatment for chronic posterior ankle pain. 8600 Rockville Pike talar neck fracture with posteromedial extrusion of the talar body should be treated operatively, even in patients with significant neuropathy, to relieve soft-tissue and/or neurovascular compromise. J. Surg. Trauma 21, 579582. 33, 871880. The role of computed tomography in surgical planning for trimalleolar fracture. The neck has approximately 15 to 20 of medial deviation and is the area most vulnerable to fractures. It is considered a serious injury which is often accompanied by ligament damage and dislocation of the ankle. As the bone remains aligned after the blow, it is usually easier to treat a non-displaced fracture as compared to a displaced fracture. This comes from a discussion I recently had with a runner during a telemedicine visit, and she called me for a second opinion. Trauma 10, 142144. 41, 5256 (2002). This could be a subtle difference to a type 3 talus fracture and was not originally part of the classification system. Therefore, adoption of the surgical option depends on the degree of joint involvement and the degree of displacement of the posterior process fragment. Addressing posterior malleolar ankle fractures. . Fractures of talar posterior process have three types, namely an isolated fracture of either medial or lateral tubercle and a simultaneous fracture of medial and lateral tubercles (i.e. This research was approved by the Ethics Committee of the affiliated hospital of the medical school of Ningbo University. The remaining cases were cast before preoperative examination. Treatment of posterior ankle pain by excision of a bipartite talar fragment, Clifford R. Wheeless, III, M.D. Once the posterior tibial neurovascular bundle and the flexor hallucis longus tendon were identified, they were retracted medially to achieve excellent exposure of the medial tubercle, lateral tubercle and FHL tendon groove (Fig. Int J Surg Case Rep. 2017;41:360-365. doi:10.1016/j.ijscr.2017.10.062. Subtalar dislocation accounts for 12% of all dislocations which makes treatment methods of talar posterior process fracture extremely rare10. Provided by the Springer Nature SharedIt content-sharing initiative, Journal of Orthopaedic Surgery and Research (2022). The posteromedial approach is a popular incision, used by the majority of surgeons. The FHL tendon served as a marker of fracture reduction. Epub 2012 Feb 21. Cedell, C. A. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. - minimally displaced fractures are treated w/ short leg cast for 4 to 6 weeks; Mao, H., Wang, H., Wang, L. & Yao, L. Definition of a safe zone for screw fixation of posterior talar process fracture by 3-dimensional technology. All cases in this study were diagnosed based on CT scans, in which the fracture line and displacement were assessed for surgical protocol design. Simulation of inserting the virtual computer-aided design (CAD) screw (diameter 3.0mm) was performed, after obtaining three-dimensional (3D) reconstructions of original CT scans. 6 Hospital, Ningbo, Zhejiang, China, The Medical School of Ningbo University, Ningbo, Zhejiang, China, Department of Orthopaedic Surgery, Ningbo No. 4). Clinical outcome and concomitant injuries in operatively treated fractures of the lateral process of the talus. Intraoperative fluoroscopy photo of percutaneous screw implanted with the minimally invasive technique. - nonunions are uncommon: PubMed The fracture was then reduced temporarily and stabilized with two guide pins and the reduction was confirmed with fluoroscopy. https://doi.org/10.1097/MD.0000000000013331 (2018). Key words: talus, fracture, talar neck, talar head, talar body, lateral process, posterior process, talar extrusion, orthopaedic surgery, review. Further future, randomized trials will help determine whether percutaneous screw fixation associated with posterior talar process fracture truly influences the rate of subtalar arthritis formation when compared with the ORIF technique with posteromedial approach. The clinical and radiological results were assessed after 4 and 12months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. Foot and Ankle 10, 235238 (1990). The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. In addition, the short follow-up time might have not been adequate for complications such as ankle and subtalar joint osteoarthritis to develop. Treating complicated ankle fractures. 6). Treatment of posterior ankle pain by excision of a bipartite talar fragment, Fractures of the Distal Tibial Metaphysis, Orthopaedic Specialists of North Carolina. Our study suggests that the two fixation techniques that were investigated are ideal methods for posterior talar process fracture with good clinical outcomes. 1). Article Complications include avascular necrosis , posttraumatic arthritis , and union issues (e.g., malunion, 57, 643646. The approach of the ORIF surgical technique was modified according to the method described in Shi et al19. If the symptoms persist; an additional period of immobilization (4 to 6 weeks) might be required. https://doi.org/10.1053/j.jfas.2012.02.007 (2012). TIBIAL STRESS FRACTURE Reza Maulana Abstrak. If they do that and they have pain in the back of the ankle, that can signify that you actually have inflammation of that tendon, or you have inflammation and irritation of the posterior process of the talus, so thats something to think about and check. K. Ramachandra Kamath, Sharan Mallya & Atmananda Hegde, Zhongzheng Wang, Yuchuan Wang, Yingze Zhang, Leon-Gordian Koepke, Annika Heuer, Lennart Viezens, Scientific Reports & Zhang, L. Medial subtalar dislocation associated with fracture of the posterior process of the talus. The appropriate 7th character for initial encounter should also be . This type of fracture may result in severe complications due to missed diagnosis, delayed or inappropriate treatment. TREATMENT Goals of treatment: 1. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The talus is the key articular segment linking the leg and foot, and as such, is subject to complex loads and may occasionally fracture. 27816 - Closed treatment of trimalleolar ankle fracture. Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, No. A future randomized and controlled study with larger number of cases is necessary to obtain more reliable results and draw conclusions for both techniques. 128, 593598. Mao, H., Wang, H., Zhao, J. et al. Ankle fractures (broken ankle). Type 1: a small chip or avulsion fracture (< 0.5 cm): 1a - Small (extra-articular) fragment of the lateral process of the talus; 1b - Small fragment of the isolated medial tubercle of the posterior process; Symptoms get worse with exercise, particularly running, and ease with rest. Terminology Fractures of talar posterior process are very uncommon injuries as these fractures cannot be discovered with standard X-ray1,2. AJR Am J Roentgenol. This allows your surgeon to reposition the fragments and secure them with plates and screws. Crutches are advised initially. This typically involves the separation of the posterior tibial insertion of the PCL to variable degrees. 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