[Analysis of diagnosis and treatment of talus lateral process fracture]

To analyse and summarize the diagnosis, treatment, and clinical effects of talus lateral process fracture.

Between February 2001 and March 2009, 21 male patients with an average age of 33.6 years (range, 18-46 years) with talus lateral process fractures were treated. Fracture was caused by falling from height in 18 cases, by tumbling in 2 cases, and by sprain in 1 case. According to Hawkins classification, there were 4 cases of type I, 15 cases of type II, and 2 cases of type III, all being closed fractures. The disease course was from 2 hours to 26 days. In 17 patients whose fracture fragments were more than 1 cm x 1 cm x 1 cm or whose fracture fragments shifting was more than 1 mm, open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients, open reduction and internal fixation with door-shape self-made nail in 1 patient, and open reduction and internal fixation with absorbable screws in 2 patients. In 4 patients whose fracture fragments were less than 0.6 cm x 0.5 cm x 0.5 cm or whose fracture fragments shifting was less than 1 mm, fragments removal was performed in 2 patients, Kirschner pins in 1 patient, and plaster conservative therapy in 1 patient. In patients with ligaments injury, the ligaments was reconstructed during the operation.

All the incisions achieved primary healing. Twenty-one patients were followed up 9.5 months to 8 years. No ankle pain occurred and the range of joint motion was normal after operation. The X-ray films showed that all cases achieved fracture union. And the healing time was from 8 weeks to 14 weeks (10 weeks on average). According to American Orthopaedic Foot & Ankle Society (AOFAS) for foot, the results were excellent in 17 cases, good in 3 cases, and moderate in 1 case; the excellent and good rate was 95.24%.

The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus; in patients who are complicated by lateral malleolus ligament injury, the ligament should be reconstructed to avoid the chronic non-stability of lateral ankle.