posterior talus fracture treatment

6, 21, 23, 24. In some cases, the bone will not need to be repositioned, and the fragment can be secured without surgery. Talar head fractures can be treated conservatively if nondisplaced, warranting careful radiographic and CT evaluation to assess rotation, displacement, and extension into the neck. Cadaver specimen with tibial neurovascular bundle accompanied with the FHL tendon, which is located at the level of the posterior ankle joint. Article This is commonly referred to as a trimalleolar fracture in which all three bone structures are broken. Surg. S92.1 Fracture of talus. - look for tenderness and perhaps a mass just posterior to medial malleolus and pain w/ motion ofgreat toe (due to motion ofFHL); If the symptoms persist; an additional period of immobilization (4 to 6 weeks) might be required. Your doctor may give you pain relief medications to help reduce swelling. 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 The fractures were classified as coronal (11), sagittal (6) and crush fractures (2). TALAR NECK FRACTURES Most common type of Talar Fractures It is so called, if # inferior line is distal to Lateral process of Talus AVIATORS ASTRAGALUS : Pilots resting the sole of the foot on the rudder bar in crashing plane at the point of impact causes Hyperdorsiflexion of ankle causing Talar neck # . Foot Ankle Int. doi:https://doi.org/10.1016/j.fas.2018.11.013 (2018). Doc on the run. Addressing posterior malleolar ankle fractures. The talus is situated below the tibia and fibula (lower leg bones) and connects with these . Avulsion fractures of the medial tubercle of the posterior process of the talus. J. and transmitted securely. TIBIAL STRESS FRACTURE Reza Maulana Abstrak. To obtain This current concepts review discusses the pathomechanics, presentation, workup, treatment, and prognosis of fractures of the talar head, neck, body, lateral process, posterior process, and talar extrusions. Talus mobilization for ankle mobility. Cannulated screws are recommended for fracture fixation with small fracture fragments and articular cartridge. Valderrabano, V., Perren, T., Ryf, C., Rillmann, P. & Hintermann, B. Snowboarder's talus fracture: treatment outcome of 20 cases after 3.5 years. Wijers, O., Engelmann, E. W. M., Posthuma, J. J., Halm, J. The postoperative VAS and AOFAS scores were comparable, with no significant differences between the two techniques. The posterior talofibular ligament attaches to the lateral tubercle and flexor hallucis longus runs between these two tubercles. Melenevsky Y, Mackey RA, Abrahams RB, Thomson NB 3rd. Defination: a pott's fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli . Clipboard, Search History, and several other advanced features are temporarily unavailable. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications. There were no significant differences for AOFAS scores and VAS scores between the two groups at 4 and 12months postoperatively (p>0.05) (Tables 1,2). Orthopaed. Our study suggests that the two fixation techniques that were investigated are ideal methods for posterior talar process fracture with good clinical outcomes. von Winning, D. et al. 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. The posterolateral approach involves a longitudinal incision between the lateral border of the fibula and the Achilles tendon26. All rights resvered. Fractures of talar posterior processes are prone to be misdiagnosed with primary plain radiographs (i.e. 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. Content is reviewed before publication and upon substantial updates. (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. 2012 Apr;29(2):187-203, vii. 27824 - Closed treatment of fracture of weight bearing articular portion of distal tibia (pilon or tibial plafond), with or without anesthesia. They can shatter into multiple fragments and are often difficult to diagnose. Operative treatment of posterior malleolar fractures. Terminology Ankle fractures (broken ankle). 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. New Zeal. The methodological improvement in this study was a good option depending upon the size and displacement of the fracture fragment. 19, 255258. Treatment of an avulsion fracture typically includes resting and icing the affected area, followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. In one case series, 17 of 20 patients with fractures were . Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This approach is especially suitable for patients who have multiple comorbidities and a higher perioperative risk. Nonsurgical Treatment Many posterior malleolus fractures are small and do not require surgery. in posterior impingement is believed to be the result of bone impaction and thus represents bone contusions or occult fractures. HHS Vulnerability Disclosure, Help AVN occurred more often in cases of a combined neck-body fracture, than in cases of isolated body or neck fractures. The main manuscript text was written by H.M. Foot and Ankle 10, 235238 (1990). TREATMENT Goals of treatment: 1. American Academy of Orthopaedic Surgeons. Am. 10.1136/bcr-2012-007763; Guler F, Ozyurek S, Turan A, Kose O: A large bone fragment posterior to talus following medial subtalar dislocation. Description. Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School, Ningbo University, No. First, you'll be placed in a splint to keep your foot and ankle from moving. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12months postoperatively for both techniques. A. https://doi.org/10.1177/107110079801900915 (1998). Google Scholar. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Because the ankle is vulnerable to twists and compression, the fracture of these bones is not uncommon and can sometimes be difficult to treat. J. Pediatr. 110 West Rd., Suite 227 Recognizing the influence of the anatomic region on the accuracy of assessing the screw position preoperatively can help the surgeon avoid placing screws that penetrate the articular facet or injuring the neurovascular bundle and tendon, as described in previous literature8,15. Tags: talar dome fracture , ankle pain , bone problems , stress fracture Recommended Products Walking Cast - High Top Pneumatic As low as $67.96 Ankle Support - Elastic As low as $8.46 Ankle Wrap - Figure-8 As low as $8.46 Swede-O Ankle Lok Brace As low as $25.46 MalleoLoc Ankle Brace official website and that any information you provide is encrypted Intraoperative photo of percutaneous screw implanted with the minimally invasive technique. Some studies in the literature have reported that up to 40% of these fractures may be missed on initial presentation using X-ray 21,22,23. J. Orthop. Initial treatment of posterior impingement . Another way to do this is to go through dorsiflexion with a posterior glide on the talus. The yellow arrow is a cannulated screw. Posterior Malleolus Fractures Posterior malleolus fractures can be challenging to an orthopedist since the fracture pattern is often irregular. 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. Intraoperative fluoroscopy photo of percutaneous screw implanted with the minimally invasive technique. Treatment. Treatment of posterior ankle pain by excision of a bipartite talar fragment, Fractures of the Distal Tibial Metaphysis, Orthopaedic Specialists of North Carolina. 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. 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. Skin sutures were removed 14days postoperatively and the operated limb was immobilized with a short non-weight bearing leg cast for another 6weeks. To the authors knowledge, there are few descriptions of surgical techniques for fractures of posterior talar process in the literature8,13,19. The incision is located at the middle line between the Achilles tendon and the medial border of the medial malleolus19. Update on talar fracture patterns: a large level I trauma center study. PubMed They can shatter into multiple fragments and are often difficult to diagnose. The most common site of talus fractures is at the talar neck followed by the lateral process. Majeed, H. & McBride, D. J. Talar process fractures: an overview and update of the literature. The tibia is commonly referred to as the shin bone, while the fibula is the thinner leg bone adjacent to it. - inversion of ankle may avulse tubercle leaving PTFL intact; For clinical assessment, considerable improvements were observed for the AOFAS and VAS scores at 4 and 12months postoperatively in both techniques. Interv. The posterior process is this big bump that you see sitting on the back of the talus sitting over your heel bone. The tibialis posterior muscle originates from the back of the tibia and fibula (lower leg bones), it then . The posterior talar process fracture is an uncommon fracture and is frequently undiagnosed by orthopaedic surgeons. Excision of ununited fractures of the posterior process of the talus: a treatment for chronic posterior ankle pain. entire posterior process fractures). Seven patients exhibited posterior process fractures associated with concomitant subtalar dislocation, three talar body involvement and two concomitant avulsion fracture of lateral malleolus. Posterior cruciate ligament (PCL) avulsion fractures are a type of avulsion fracture of the knee that represent the most common isolated PCL lesion. The AOFAS and VAS scores were used to analyze the treatment outcomes. doi:https://doi.org/10.1007/s00402-007-0459-8 (2008). 226230 (1994). . Trauma 21, 579582. One or two screws were positioned for fixation of the medial and lateral tubercle of the posterior talar process (Fig. Fractures of both tubercles will usually be treated conservatively if there is minimal displacement. No patients complained of stiffness in the ankle and subtalar joint. Further, a trial of cast immobilization of acute posterior or lateral talar process fractures of at least 6 weeks is useful, . Cite this article. The usual mechanism of injury is forced hyperplantarflexion and inversion causing direct compression of the posterior talus, or an avulsion fracture caused by the posterior talofibular ligament. To evaluate the surgical outcomes of talar, posterior process displaced fractures with posteromedial approach. A CT scan is recommended in order to reveal the fracture type and assess the displacement of the fracture fragment12,29. The study aimed to observe and provide anatomical data related to posterior process of talus in Asian adults and explore the . Wu JQ, Ma SH, Liu S, Qin CH, Jin D, Yu B. Orthop Surg. Nondisplaced fractures can be managed with a trial of nonoperative immobilization. PubMed The average follow-up period was 13months (816months). Clinical outcome of closed isolated subtalar dislocations. If that happens and you have chronic pain, well, you need to address it. It is necessary to avoid complications of pain, nonunion and tarsal tunnel syndrome for the treatment of these fractures3,4,5. One or two 3.0mm cannulated screws were applied as a lag screw function (Fig. CAS Crutches are advised initially. A future randomized and controlled study with larger number of cases is necessary to obtain more reliable results and draw conclusions for both techniques. Today on the Doc On The Run Podcast were talking about posterior process fractures of the talus. Talar fractures are divided by anatomic region: head, neck, and body. 4). Firstly, deviation may be present in the results due to the nature of the research being retrospective and most importantly due to the limited number of cases. Google Scholar. The clinical data was offered by K.W.. Initial assessment of treatment of talar posterior process fractures with open reduction and percutaneous fixation, https://doi.org/10.1038/s41598-020-77151-6. Chirop. It's also not very comfortable. Nonsurgical treatment includes restricted weight-bearing, patellar tendon-bearing braces, and extracorporeal shockwave therapy. Talus fracture treatment algorithm . Verywell Health's content is for informational and educational purposes only. Careers. Minimal displacement of fracture fragment with percutaneous screw fixation was recommended. Most avulsion fractures heal very well without surgical intervention. Injury 46, 759762. Shi, Z., Zou, J. Fan Z, Ma J, Chen J, Yang B, Wang Y, Bai H, Sun L, Wang Y, Lu B, Dong BC, Tian A, Ma X. J Orthop Surg Res. With that being said, there remains controversy as to when it is most appropriate. Am. It is considered a serious injury which is often accompanied by ligament damage and dislocation of the ankle. https://doi.org/10.1053/j.jfas.2012.02.007 (2012). 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. 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. Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Fractures of the talus: a comprehensive review. 6 Hospital, Ningbo, Zhejiang, China, The Medical School of Ningbo University, Ningbo, Zhejiang, China, Department of Orthopaedic Surgery, Ningbo No. . The AOFAS scores using the ORIF technique were improved from 64.5 to 83.5 at 4months postoperatively, and to 82.8 at 12months postoperatively. 2017;31(4):e116-e120. 2,8 . Fractures that are often not out of place and in patients who are not active, can be managed well with conservative or non-surgical treatment. https://doi.org/10.1097/MD.0000000000013331 (2018). Complication rates were high, ranging between 6% SSI up to 64% osteoarthritis, following operative treatment of talar fractures. 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. sharing sensitive information, make sure youre on a federal Informed consent was obtained from the patients who participated in this study. and L.Y. J. The neck has approximately 15 to 20 of medial deviation and is the area most vulnerable to fractures. https://doi.org/10.1177/1071100719868712 (2019). The scores using the percutaneous screw technique were improved from 63.5 to 84.1 at 4months postoperatively and to 83.9 at 12months postoperatively (Table 1). Repeat surgical intervention after an index treatment of a talus fracture can stem from treatment of infection, reconstruction of a malunion, revision fixation of a nonunion, or fusion/joint reconstruction of post . 58, 286290 (2014). The .gov means its official. Veazey, B. L., Heckman, J. D., Galindo, M. J. Foot Ankle Int. Normally a towel or rope works well. 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. A previous study claimed that two oblique views at 45 and 70 of external rotation may be helpful, if the plain radiographs are unclear20. Radiol. Fractures of talar posterior process are very uncommon injuries as these fractures cannot be discovered with standard X-ray1,2. Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. Orthopaed. 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 from the toe to the upper calf to immobilize the limb and protect it. 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17 In a . Open Orthop J. 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. PubMed You have to wear it until your bone heals completely. https://doi.org/10.1016/j.jvir.2012.09.006 (2012). Shibuya et al (PMID: 24785202) found that open fractures occur in approximately 20% of calcaneus and talus fractures. Diagnosing and Treating Posterior Malleolus Fractures. You are using a browser version with limited support for CSS. Fig. - lateral tubercle has an articular surface, & frx thru this tubercle is often associatted w/ arthrosis; - Frx of Medial Tubercle: Generally speaking, the best way to reposition the bone is through an incision in the back of the ankle. And so when I look at a patient and they tell me that theres pain on the back of the ankle here and I suspect maybe thats the flexor hallucis longus tendon where it rubs around the posterior process, what I do is I basically take them and I just push up on their big toe, I put my thumb under the big toe, and then Ill tell him to push down as hard as they can. Therefore, most authors in the literature consider that if the displacement of the fracture fragment is larger than 2mm and subtalar joint surface is involved, then an urgent open reduction and internal fixation is recommended9,16. 18, 219228. 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. Intraoperative photo of ORIF. 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. The posterior process has both a posteromedial tubercle and posterolateral tubercle. If your fracture is stable and your joints are well-aligned, surgery may not be necessary. Cadaver specimen with posterior ankle joint and posterior talar process. Blanchette, M. A. Fracture patterns provide clues to the underlying pathomechanics and energy of the injury, both of which can help guide treatment and suggest prognosis. Traditionally, surgeons have long recommended surgery if more than 25% of the malleoli is involved. J. Orthop. The posterior talar process fractures present in the study were classified as lateral tubercle fracture, medial tubercle fracture and entire posterior process fracture. The treatment recommended for small (<1 cm) and minimally displaced (<2 mm) fractures of the posterior process of the talus is conservative . 27816 - Closed treatment of trimalleolar ankle fracture. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. A groove containing the flexor hallucis longus tendon along the posterior talus separates the medial and lateral tubercles of the posterior talus. Though uncommon, in some cases, people may need to undergo surgery to have the surgical hardware removed later on down the road. A shift>2mm indicated significant displacement with surgical treatment. 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. a case report. BMJ Case Rep. 2013, 16:2012007763. More often, breaks will occur when the medial and lateral malleolus are also involved. Instead, surgery should be performed if the posterior malleolus fracture causes any instability of the ankle joint, irrespective of the size or location of the fracture.. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. Statistical differences between the times of clinical and radiographic resultswere analyzed using One-Way ANOVA test followed by post hoc multiple comparison with Bonferroni test. 57, 643646. 51, 326329. 47, 11701175 (1965). The ORIF technique with posteromedial approach was a good option for comminuted fracture and supported by previous literature19. Relat. 2019 Aug 7;20(1):363. doi: 10.1186/s12891-019-2738-2. and J.Z. 3, 8592. Epub 2012 Feb 21. 28445 Open treatment of talus fracture, includes internal fixation, when performed 28465 Open treatment of tarsal bone . No complications such as screw loosening, nonunion, or malunion were reported and no patients complained about stiffness of the ankle and subtalar joint. A posterior talar process fracture is a significant foot injury that can lead to a long road to recovery. https://doi.org/10.1302/2058-5241.3.170040 (2018). How your fracture is treated depends on which type it is and what caused it. & Schepers, T. Functional outcome and quality of life after nonoperative treatment of posterior process fractures of the talus. PubMedGoogle Scholar. This is a small canal where nerves pass . 9 Hospital, Ningbo, Zhejiang, China, You can also search for this author in So unfortunately, if you have an injury and we go looking for your trouble, as soon as we find something, well, a lot of times doctors see it and they think, well, thats the problem, and they make the diagnosis of that thing, but then they miss the other thing sometimes. From January 2008 to December 2010, 18 patients with displaced fracture of talar poste. Scientific Reports (Sci Rep) Use of a 30-degree external rotation view for posteromedial tubercle fractures of the talus. Seven cases of posterior process fractures associated with concomitant subtalar dislocation were reduced and stabilized by emergency cast. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. Therefore, this technique is the most common treatment described in previous literature12,13,14. 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. Because an isolated fracture of this sort is so rare, diagnoses are sometimes missed or inconclusive. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. This is due to attachments of ligaments between the two bones. AP: avulsion fracture, joint >2mm wide. the posterior and the lateral. Treatment usually includes a period of immobilization followed by gradual return to activity. Foot Ankle Surg. No infection or nerve injury was observed in both groups. Answer From Edward R. Laskowski, M.D. Cedell fracture: Posterior talar process fracture with injury to the posteromedial tubercle caused by forced dorsiflexion and pronation. Fractures of talar posterior process are very uncommon injuries as these fractures cannot be discovered with standard X-ray 1,2.This type of fracture may result in severe complications due to . https://doi.org/10.1097/BOT.0b013e31804ea0d9 (2007). Avulsion fractures of the medial tubercle of the posterior process of the talus. ISSN 2045-2322 (online). Podiatry Today. Towson, MD 21204 EFORT Open Rev. Therefore, adoption of the surgical option depends on the degree of joint involvement and the degree of displacement of the posterior process fragment. ORIF was performed when soft tissue swelling was reduced, while swelling did not affect the percutaneous screw fixation procedure. The talus is sandwiched in between these two, and you can see its sitting there squished right in between the tibia and the heel bone. Access and reduction of displaced or comminuted fracture fragments is a challenging procedure for surgeons due to the rarity of fractures of entire posterior process. The https:// ensures that you are connecting to the Well, she asked me, What exactly is a posterior process fracture? Well, all right, Ill show you. 3). Treatment is based on the alignment of the bones and the stability of the ankle joint. https://doi.org/10.1016/j.injury.2007.04.025 (2007). The minimally invasive percutaneous screw fixation technique was described by few reports8,15,27,28. The mean union time was 3months (25months). Mickel TJ, Andersen R, Keeling J, McKenna P. Foot Ankle Int. Fractures of the talar dome may be further classified into coronal . ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. [Surgical management of talus fractures: mid-term functional and radiographic outcomes]. (A) Lateral tubercle of posterior talar process; (B) medial tubercle of posterior talar process; (C) groove of the flexor hallucis longus tendon. The internal fixation of the fractures was confirmed with X-ray and CT scans after one day of operation (Fig. J. Accessibility Talus Fracture (other than neck) Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. talar body fractures were studied retrospectively to assess outcome after operative treatment. Whats the significance of that? This allows your surgeon to reposition the fragments and secure them with plates and screws. Conservative treatment is recommended for stable and nondisplaced fractures and typically involves a non-weight-bearing, short leg cast for 6-8 weeks. Considerable improvements were observed in the AOFAS and VAS scores at 4 and 12months postoperatively in both fixation techniques during clinical assessment. The FHL tendon served as a marker of fracture reduction. Approach is based on the fracture pattern and the need for both open reduction and fixation versus closed reduction and fixation. 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. 2). The fragment was then fixed with a self-tapping and drilling 3.0mm cannulated screw (Synthes Inc, Shanghai) directed from the posterior to the anterior through the fracture fragment into the body of the talus (Fig. 1). Thank you for visiting nature.com. web1! Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis. - nonunions are uncommon: The posterolateral or posteromedial approach was performed with ORIF for posterior process fractures, according to the location of the displaced fragments. (A) Medial ankle; (B) achilles tendon; (C) entry point of percutaneous screw. & Suleiman, J. Well, theres a groove right there, and the thing that sits in this groove at the back of the posterior process, it runs right through that groove, well thats the flexor hallucis longus tendon goes through there. Clinical and radiological outcomes of patients were assessed at 4 and 12months postoperatively. This comes from a discussion I recently had with a runner during a telemedicine visit, and she called me for a second opinion. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. - Frx of Lateral Tubercle of Posterior Process (Sheppard's Frx): Elderly patients with limited ambulatory capacity, similarly, may be best treated nonoperatively if the joint is not significantly displaced Injury 38, 13131317. Entire posterior process fractures are easier to identify than isolated medial or lateral tubercle fractures on plain radiographs. Foot Ankle Surg. Moreover, there is little consensus on how best to stabilize the fracture once it has been reset. By far the rarest foot and ankle fractures are those of the posterior process of the talus2. J. Cedell, C. A. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. This technique offered a good evaluation of the fixation for talar process fractures preoperatively. This could be a subtle difference to a type 3 talus fracture and was not originally part of the classification system. 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. It will be this fragment where fixation efforts will be focused. And this study stressed early surgical intervention in displaced fracture of the talar posterior process fracture. Tibialis posterior tendonitis is a condition characterized by tissue damage and sometimes swelling of the tibialis posterior tendon, usually following overuse, resulting in pain located at the inner aspect of the lower leg and ankle. Swelling was a factor to the time of surgery. B 21, 439442. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. The authors declare no competing interests. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. . In some other animals, it is the . Some studies reported different types of posterior process fractures, however, none of them defined an optimized approach and treatment. The injuries can be divided anatomically into osteochondral, lateral process, posterior process, and true body (dome) fractures. Conservative Treatment of Posterior Malleolus Fracture Usually, conservative treatment of posterior malleolus fracture, is recommended for less severe and uncomplicated injuries. Foot Ankle Surg. 41, 5256 (2002). 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; It should be noted, that the AOFAS score is currently not validated for most authors in the literature. Mills, H. J. Occult talar neck fracture associated with talar avulsion diagnosed by MRI: a case report. In total 35 cases of posterior talus fractures have been reported. PMC Nasser, S. & Manoli, A., 2nd. Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. Carousel with three slides shown at a time. There is likely to be tenderness and possibly swelling over the sinus tarsi. Liu, Z., Zhao, Q. Unable to load your collection due to an error, Unable to load your delegates due to an error. Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. - clinical findings: 40, 14031407. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. An official website of the United States government. Differential diagnosis Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon. The cause of injury for eight of the cases was vehicle accident and for four of the cases sport injury. 45, 454461 (1974). The experiment was conducted in accordance with the Declaration of Helsinki (World Medical Association). Fractures of talar posterior process involve an isolated fracture of either medial or lateral tubercle and simultaneous fracture of the medial and lateral tubercles (entire posterior process fractures)4,6. 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 . Res. Scand. The unfused ossification center of the lateral tubercle forms the os trigonum. The talus is a small bone of the ankle responsible for transferring weight bearing forces from the shin to the foot (figure 1). https://doi.org/10.1016/j.injury.2014.12.002 (2015). Any fractures that exhibited displacement larger than 2mm involving joint surface were treated with percutaneous screw fixation or ORIF. The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using ORIF through posteromedial approach and percutaneous screw fixation. In addition, the short follow-up time might have not been adequate for complications such as ankle and subtalar joint osteoarthritis to develop. In our study, anatomical observation and classification of the posterior process of the talus were carried out, and related imaging and finite element methods were combined. Arch. Thus, adequate access to the fracture fragments and using lag screws for fixation is achieved and for the neurovascular bundle to remain unharmed. Search. Provided by the Springer Nature SharedIt content-sharing initiative, Journal of Orthopaedic Surgery and Research (2022). Surgery will often be required to ensure the fragments are correctly placed. Elevating the foot above the level of the heart helps to minimize swelling and pain. J. The VAS scores decreased from 4.5 preoperatively to 2.0 and 1.8 at 4 and 12months post-operation, respectively, using the ORIF technique and from 5.3 to 2.2 and 1.5 at 4 and 12months post-operation, respectively, using the percutaneous screw technique (Table 2). https://doi.org/10.1097/BOT.0000000000001326 (2018). But in either case, if your pain is on the back of your ankle and it hurts when you do stuff with your big toe, for example, if youre doing calf raises, if you stand up on the balls of your feet and your heels are way up off the ground, then youre having to pull hard with your big toe to maintain your balance in that position. The Mann Whitney U test was used for the skewed distribution of cases. This type of fracture may result in severe complications due to missed diagnosis, delayed or inappropriate treatment. government site. Trauma 32, 601606. Ebraheim, N. A., Patil, V., Frisch, N. C. & Liu, X. The study provided valuable information for the minimally invasive technique of posterior talar process fracture and contributed to the accuracy of this highly demanding technique. Mehrpour, S. R., Aghamirsalim, M. R., Sheshvan, M. K. & Sorbi, R. Entire posterior process talus fracture: a report of two cases. Fractures of the anterior process account for approximately 15 percent of all calcaneal fractures and are commonly misdiagnosed as ankle sprains. The majority of the talus is articular cartilage so screws may be passed from posterior to anterior through the small non-articular portion of the bone. 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