Summary
The lateral talar process fracture occurs following an acute injury, often a sudden jamming of the ankle such as might occur during a snowboarding injury. Patients will complain of swelling and pain on the outside of the ankle. It will be difficult or impossible for them to walk. Diagnosis is with plain x-rays and may need to be confirmed with a CT scan. Treatment is often surgical, with either resection of the fragment if it is small or reduction and stabilization with screws if the fragment is larger.
Clinical Presentation
Following an acute injury, patients will present with pain and swelling in the ankle joint, particularly on the outside. Often the mechanism is a sudden stop causing the ankle to be jammed on the outside.\such as might happen during a sudden stop while snowboarding. It will often be difficult or impossible for patients to walk following a lateral talar process fracture.
Physical Examination
Physical examination will show swelling around the ankle area particularly over the outside aspect of the ankle. Patients will walk with a pronounced limp or will be unable to weight bear. Movement of the foot as well as sensation over the foot is usual intact. This condition can present similar to a severe sprained ankle.
Imaging studies
Plain x-rays of the ankle usual identify the fracture associated with the outside aspect (lateral) of the talus. However this finding can be subtle and may be missed depending on the angle that the x-ray is taken at.
CT scan or MRI can confirm the diagnosis if it is in question. Furthermore, a CT scan by giving outstanding resolution of the bones can determine whether the fracture is a clean break or broken into smaller fragments (comminuted).
Treatment
A small talar process fracture that is well positioned may be treated non-operatively. However, in some patients, surgery to reposition and stabilize the fracture is necessary. Non-operative treatment typically involves immobilization in a cast or walker boot with limited or no weight-bearing for approximately 6 weeks in order to allow the fracture to heal
Surgical Treatment
Surgical treatment consists of either removing (excising) the fracture fragment or stabilizing the fracture with screws.
Excision of the lateral process fragment
If the fracture is small or broken into many fragments excising these fragments is often best. In this instance, once the swelling is settled down, patients may be mobilized aggressively.
Surgical stabilization of the fracture
In most instances, the fracture fragment is of a large enough size, and may be displaced to the point where reducing this fragment (putting it back in its original position) and stabilizing it with a screw or screws is indicated. In this instance, approximately 6 weeks of non-weight bearing in a cast or walker boot is required to allow for adequate healing. After healing has been documented on x-ray patients can be aggressively mobilized.
During the healing phase (0-6 weeks) it may be helpful to keep the ankle and hindfoot joints moving so that limited loss of ankle motion occurs. Once the patient can begin full unrestricted weight bearing, aggressive strengthening and stretching exercises, as well as, balance (proprioception) exercises are instituted.
Potential Surgical complications
The usual array surgical complications exist for this procedure, including:
Infection
Wound healing problem
Nerve (sural nerve) damage
DVT
Pulmonary embolism
Complex region pain syndrome (CRPS)
Complications that are specific to this injury include:
Sub-talar arthritis as this fracture does involve the sub-talar joint.
Revised 10.11.2011
