Keywords

Moderate energy injury—treatment dictated by articular congruity .

Overview

  • Classic mechanism is inversion with dorsiflexion and axial load (“Snowboarder’s fracture ”)

  • Frequently missed on plain radiographs so high index of suspicion for patients with severe pain and exam consistent with “ankle sprain”

Physical Exam

  • Skin intact? Amount of soft tissue swelling?

  • Distal neurovascular exam (Appendix B)

Diagnosis

Imaging

  • AP and Lateral XR of foot (lateral process best viewed on AP image) (Fig. 1)

  • CT scan can help with diagnosis when clinical concern but X-rays negative. Also helpful in determining ultimate treatment (operative vs. nonoperative) based on fracture displacement.

Classification

Based on anatomic location

  • Type 1: Tip of lateral process (doesn’t involve articular surface)

  • Type 2: Lateral process involves subtalar or tibiotalar joint

  • Type 3: comminuted lateral process

Treatment Plan

Decision for operative vs. nonoperative treatment based on fracture displacement/comminution.

Nonoperative

  • Indication: minimally displaced fractures (<2 mm).

  • Treatment: immobilization in a short leg cast (Appendix B: Short leg cast) 4–6 weeks, initially NWB

    Fig. 1
    figure 1

    Lateral process of talus fracture

    Full size image

Operative

  • Indications: fractures with >2 mm displacement or severe comminution

  • Treatment:

    • Displaced fractures—ORIF

    • Severely comminuted fractures—lateral process fragment excision