ORIF found effective for lateral process talus fractures

By Elaine Fiedler

Surgical treatment of lateral process of the talus fractures provides patients with a good chance of resuming normal activities despite multiple injuries, said the authors of Paper 214 Thursday. Their retrospective review also found that open reduction and internal fixation (ORIF) may help patients avoid subtalar arthritis and future fusions.

The study identified 28 patients treated for lateral process of the talus fractures at a level one trauma center from June 1997 to July 2003. Of these, 26 were treated with ORIF and two with local debridement; 24 were available for follow-up.

Motor vehicle collisions and falls from a height were the most common mechanisms of injury in this study. Patients commonly had other injuries as well: 57 percent had ipsilateral foot and ankle fractures, 11 percent had contralateral foot and ankle fractures, and 32 percent had operative orthopaedic injuries not involving the foot and ankle.

The radiographs from the 24 patients revealed no evidence of nonunion, loss of reduction, or post-traumatic arthritis. Twelve patients completed the Short Musculoskeletal Function Assessment Questionnaire (SMFA); scores ranged from 1.1 (low disability) to 84.3 (higher disability). The mean follow-up for patients who completed the survey was 3.4 years (range: 18 months-6.5 years). Of the 12, one has undergone hardware removal; no other surgeries or fusions have been performed.

This is the largest series of surgically managed fractures of the lateral process of the talus reported in the literature. Surgical repair led to adequate restoration of alignment in all cases seen in follow-up. Although the two-year follow-up was limited, data suggest that commonly associated injuries with this trauma often lead to poor outcomes.

The authors noted that “very few of our fractures were truly simple in nature and usually a combination of both large fragments and comminution.” Isolated lateral process fractures treated with ORIF have good functional outcomes and reduce the risk of subtalar arthritis and fusions.

More follow-up studies are needed, including radiographic follow-up and prospective, randomized studies of closed versus open treatment for greater clarity.

The authors include Darcy Foral, MD; John Early, MD; and Mark Perry, MD, all of Dallas.

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