Lateral process fracture of talus in adolescents: easily missed ankle injury

Objective To explore the clinical characteristics, treatment and outcome of lateral process fracture of talus in adolescents. Methods From March 2011 to October 2013, 12 children (8 boys, 3 girls) with lateral process fracture of talus were recruited. The injuries were at left (n=8) and right (n=4) sides. The age range at the time of injury was 8-13 years. The causes of injury were falls (n=5), standing long-jump (n=2), fall down stairs (n=3) and bicycle accident (n=2). And the concomitant injuries included nondisplaced calcaneus fractures (n=1) and distal fibula epiphysis injury (n=1). Their presentation time was 2 hours to 2 months after injury. All cases were classified by the Hawkins fracture system. Treatments included immobilization plus non-bearing weight for 4 weeks for nondisplaced fractures or open reduction and fixation for displaced fractures. Results Among them, 7 cases were initially diagnosed at our department and 5 cases had a missed diagnosis at other hospitals. The missed diagnosis rate was 42%. During an average follow-up period of 18 months, there was no radiographic evidence of avascular necrosis of talus, nonunion or malunion. According to the American Orthopedic Foot & Ankle Society (AOFAS) score, the outcomes were excellent (n=10), good (n=1) and fair (n=1). Conclusions The lateral process of talus fracture is frequently missed. A definite diagnosis is dependent upon careful physical and imaging examinations. And optimal therapy is selected by displacement extent and fracture type. Key words: Talus; Fractures, bone; Ankle injuries; Adolescent