A Closer Look At Lateral Talar Process Fractures With Snowboarding Injuries
- Volume 22 - Issue 2 - February 2009
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A similar study by Valderrabano, et al., reviewed 26 patients from 1999 to 2001 for sustained LTP fractures. 16 Researchers obtained appropriate radiographic views due to a high suspicion of LTP fracture. Eighty percent of all reported cases were classified as type II fractures, type I fractures accounted for 15 percent and type III fractures accounted for 5 percent, according to the Bladin-McCrory injury classification system.
Again, patients underwent treatment according to type and severity. Type I and III cases were non-operative. In regard to patients with type II injuries, researchers used non-operative treatment in two cases and employed open reduction in 14 cases. Each type had only one that required revision.
The AOFAS hindfoot scoring system determined that the mean average score was approximately 93 points out of 100. Again, alignment was a perfect 10 out of 10 at 3.5 years. Function was approximately 47 out of 50.
According to Sariali, et al., in their review of 43 patients over 17 months, delayed diagnosis and under-treatment of LTP fracture inevitably result in specific pseudoarthrosis and/or STJ osteoarthritis.22 Still, with such results, it is hard to deduce exactly how many will experience degenerative changes of the STJ secondary to trauma and by how much. Understandably, though, there will be some degree of change nonetheless. These results continue to illustrate that early detection and appropriate treatment will result in satisfactory outcomes.22
Based on these results, Langer and DiGiovanni have recently conducted further evaluation about the incidence of fracture types of the LTP.23 These injuries were not specific to the snowboarding mechanism as researchers assessed these as isolated LTP fractures in the general trauma population. This retrospective review of patients between 2000 and 2005 demonstrated that there was a 10.4 percent incidence of LTP fractures in the general trauma population. They found that the most common presentation was a single large fracture fragment. This was followed by a non-articular chip fracture and ended with the comminuted type of fracture.23
Since its conception, snowboarding has increased the number of ankle injuries we see in practice. With the knowledge that we have gained from the early works of Hawkins as well as recent contributions by Boon, Funk, Kirkpatrick and many others, there is a better understanding about LTP injuries that occur with snowboarding.1,2,11,13
One may utilize one of the aforementioned classifications to help determine the appropriate treatment regimen. However, it remains up to the physician’s knowledge and experience to determine whether the injury is significant enough to require ORIF or whether one should administer conservative methodology.
Mr. Robertson is a fourth-year medical student at the New York College of Podiatric Medicine.
Dr. Khan is a Clinical Assistant Professor in the Department of Medical Sciences at the New York College of Podiatric Medicine.
Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt College. He is a Past President of the American Academy of Podiatric Sports Medicine.
Editor’s note: For related articles, see “Secrets To Treating Ankle Fractures In Athletes” in the January 2007 issue of Podiatry Today or “Ski Boot Orthotics: Plowing Through The Options” in the December 2002 issue.