The lateral talar process is one of the check areas on an ankle series for any patient with lateral pain. The type of treatment depends on the fracture grade 6: If symptomatic non-union occurs, debridement may be necessary. Often they are seen in only one of the frontal or oblique views. Coronal CT image of the same patient demonstrates a minimally displaced, comminuted fracture through the lateral process of the talus, which extends to the talofibular and subtalar joints. Recognition of the unique talar anatomy is important for correct diagnosis. 4. . Chip and avulsion fractures are the most common fractures of the talus, followed by talar neck fractures (Sanders 2010). Lateral process talus fractures are commonly seen in snowboarders and are sometimes called "snowboarder fractures." Avulsion fractures. The cuboid makes up the midfoot's contribution to the lateral column of the foot and serves mainly as a lateral column spacer block. FRACTURE OF THE LATERAL PROCESS OF THE TALUS. CT. Axial bone window. Lateral ankle soft tissue swelling. The anterior talofibular ligament shows three bands of different thicknesses. Mosby. Radiographics. Although the talus is intimately involved in the . The fragment is difficult to visualize on the lateral projection because of the overlying calcaneus. Frequently missed findings in acute ankle injury. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. Recognition of the unique talar anatomy is important for correct diagnosis. . Often they are seen in only one of the frontal or oblique views. Jibri Z, Mukherjee K, Kamath S et-al. Soft tissue swelling over the lateral malleolus. AP . ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. These fractures are avulsion fractions of the ossification center of the lateral condyle and as such are sometimes referred to as a lateral epicondyle fracture and sometimes as a lateral epicondyle avulsion fracture. 3. Alignment has been maintained. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Incidental note of os subfibulare and os trigonum. The medial and lateral malleoli, together with the horizontal plate of the distal articulating surface of the tibia, constitute the ankle mortise that receives the dome-shaped superior articulating surface of the talus. (2B) Sagittal T2-weighted fat-suppressed image through the talar neck demonstrates the thin, low signal intensity cortical avulsion fracture (arrow) as well as marked thickening and edema-like signal throughout the dorsal talonavicular ligament (arrowheads). 1 article features images from this case No effusion in the anterior recess of the ankle joint. 2004;24 (4): 1009-27. A minimum of three viewsAP ( Figure 12-1 A ), internal oblique ( Figure 12-1 B ) and lateral ( Figure 12-1 C )should be obtained.In some cases fractures of the phalanges are seen only on the internal oblique view and, therefore, may be overlooked if the internal oblique is omitted. Annotated image. . We will review talar fractures, calcaneal, midfoot fractures. A Cedell fracture is a fracture of the medial tubercle of the posterior process. One of the first stages in this injury is rupture of the anterior tibiofibular ligament (or anterior syndesmosis). Distally, it articulates with the fourth and fifth metatarsals. An elongated lateral tubercle of the posterior process of the talus is referred to as a Stieda process, so occasionally these fractures are described as Stieda process fractures. Talus, lateral dome 6 (15) 19 (24) . 2. Incidental note is made of an os trigonum. A talar avulsion fracture occurs when a small part of your talus bone pulls away from the rest of the bone where it's attached to a ligament or tendon. This type of fracture often occurs during a high-energy event, such as a car collision or a fall from a significant height. Check for errors and try again. The lateral talar process is one of the check areas on an ankle series for any patient with lateral pain. Recognition of the unique talar anatomy is important for correct diagnosis. Foot - The Primer 1 Radiographic examination . The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. Incidental note is made of an os trigonum. Fig. Lateral . The lateral talar process is one of the check areas on an ankle series for any patient with lateral pain. J Bone Joint Surg Am. Problem Solving in Musculoskeletal Imaging. The predominantly extraosseous vascular supply of the talus predisposes it to significant injury in the setting of trauma. Check for errors and try again. {"url":"/signup-modal-props.json?lang=gb\u0026email="}, Hacking C, Lateral talar process avulsion fracture. 2015;35 (3): 765-79. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. Unable to process the form. 2 Classification for calcaneal avulsion fractures. Semin Musculoskelet Radiol. talar dome osteochondral fracture; posterior talar process fracture; lateral talar process fracture {"url":"/signup-modal-props.json?lang=us\u0026email="}, Hacking C, Lateral talar process avulsion fracture. The ankle includes the distal end of the tibia, the fibula, and the talus. The lateral talar process is one of the check areas on an ankle series for any patient with lateral pain. 1996;47: 1170-5. With an avulsion fracture, an injury to the bone occurs near where the bone attaches to a tendon or ligament. J Ultrasound Med. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Mosby. Gender: Male. They are distinct from a lateral condyle fracture which although it has a similar name, it a very different . The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. Radiopaedia.org, the wiki-based collaborative Radiology resource Osteoarthritis and occult lateral talar process fractures also produce talar facet and lateral talar bone marrow edema. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. X-ray. A talus fracture is a break in one of the bones that forms the ankle. Talus Fracture (other than neck) Talus fractures (other than neck) are rare fractures of the talus that comprise of talar body fractures, lateral process fractures, posterior process fractures, and talar head fractures. Unable to process the form. Lateral talar process avulsion fracture . The hip, elbow and ankle are the most common locations for avulsion fractures in the young athlete. Fig. A fracture is a break or crack in a bone that often results from an injury. Unable to process the form. Lateral talar process fracture. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Benoudina S, Hacking C, et al. contusion and small avulsion fracture of the anterior process of the cal-caneus (white arrow). Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. (Canale, 1978) Advanced imaging is often necessary to better characterize the fracture pattern or . Although talar fractures account for less . External rotation injury of the ankle is the most common ankle injury and can lead to a Weber B or Weber C fracture. 2 Classification for calcaneal avulsion fractures. Type 1 is simple avulsion with variable sized bone fragment, type 2 is beak fracture with horizontal fracture extending into posterior body, type 3 is avulsion by superficial fibers of middle third of Achilles tendon, and type 4 is small beak fracture avulsed from deep fibers of tendon. ISBN:0323072437. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The chronic fracture may then require a subtalar fusion. Morrison WB, Sanders TG. fluid-sensitive sequences: if an acute injury, there may be bone marrow edema in the lateral process; T1: hypointense fracture line through the lateral process (fracture line and/or cortical step off may be better seen on CT) Ultrasound A fracture should be suspected when there is soft tissue swelling inferior to the lateral malleolus. Frontal. 2003;22 (6): 635-40. Oblique . Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-95495. Melenevsky Y, Mackey RA, Abrahams RB et-al. ADVERTISEMENT: Supporters see fewer/no ads. Sagittal bone window. Avulsion may occur from sudden tension on the Achil- Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-31923, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, fractures have been graded by a three point scale, grade 2 fractures may be further subdivided into, cortical disruption of the lateral talar process (best seen with a coronal approach). Ideally, the CT scans are formatted in two planes: the semicoronal or oblique coronal plane, which is perpendicular . When the . Examination of the foot and ankle using the Ottawa ankle rules does not include examination of the talus, an injury here is easily missed causing concern to the patient.. Check for errors and try again. The injuries can be divided anatomically into osteochondral, lateral process, posterior process, and true body (dome) fractures. The patient was examined 6 days after inversion injury to the right ankle. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-37891, Case 3: lateral and posterior process fractures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal. Coronal bone window. 2013;17 (04): 416-28. (5) 43.7% of remaining transchondral fractures of the talus occur in the middle third of the lateral talar dome. HAWKINS LG. Radiology 2002; 224:463-469 [Google Scholar] 2 . Focal tenderness and swelling over lateral malleolus was present. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. ct. Axial bone window. Thin bony fragments adjacent to the lateral aspect of tip of the lateral malleolus and cortical irregularity at the lateral talus, likely representing avulsion fractures. All three bands are hypoechoic and maintain continuity. Dorsal talus avulsion fractures occurring along the supination line of the foot can cause pain and discomfort. lateral and oblique views (Figure 1). (5) The term transchondral refers to an injury applied to the bone across the cartilage. Diagnosis is made radiographically with foot radiographs but CT scan is often needed for full characterization of the fracture. (Fig.1).1). Talar Fractures and Dislocations: A Radiologist's Guide to Timely Diagnosis and Classification. Avulsion fractures of the calcaneal tuber-osity are uncommon, accounting for 1.3-2.7% of calcaneal fractures [9]. Type 1 is simple avulsion with variable sized bone fragment, type 2 is beak fracture with horizontal fracture extending into posterior body, type 3 is avulsion by superficial fibers of middle third of Achilles tendon, and type 4 is small beak fracture avulsed from deep fibers of tendon. Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. Fractures of the talar dome may be further classified into coronal . Fractures of the tu-berosity are either from an avulsion or shear-compression mechanism of injury, with the latter constituting most fractures. Check for errors and try again. An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone. Axial view of calcaneus . Sonographic diagnosis of talar lateral process fracture. Stress fractures. Age: 30. Proximally, the cuboid has a saddle shaped articulation with the calcaneus. Unable to process the form. A talar stress fracture is a small . This is a retrospective study carried out in a major trauma centre to look at the assessment and diagnosis of all . The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. No malleolar fracture. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. The fracture occurs when the foot is dorsiflexed and inverted, as can happen with snowboarding (hence the term "snowboarder fracture")1. Talus Fractures Key Points: Pediatric talus fractures are uncommon. This is foot trauma. Minimally displaced avulsion fracture of the lateral process of the talus. ADVERTISEMENT: Supporters see fewer/no ads. 1 Department of Radiology, Einstein Medical Center Philadelphia, 5501 Old York Road, Philadelphia, PA 19141, USA . No malleolar fracture. The fragment is difficult to visualize on the lateral projection because of the overlying calcaneus. It has been suggested that fracture of the lateral tubercle may be caused by excessive plantar flexion (compression fracture) or inversion (avulsion fracture), while fractures of the medial tubercle would be the result of dorsiflexion with pronation (avulsion fracture). Avulsion fractures of talus and calcaneus. Coronal CT image of the same patient demonstrates a minimally displaced, comminuted fracture through the lateral process of the talus, which extends to the talofibular and subtalar joints. Fractures of the entire posterior process of the talus are extremely rare. 6. Pathology Location talar head fractures talar neck fractures talar body fractures . Medially, it articulates with the navicular nad lateral cuneiform. Minimally displaced avulsion fracture of the lateral process of the talus. Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. Campbell's Operative Orthopaedics. It may be an isolated fracture or occur as a component of more complex ankle fractures. Ultrasound examination (not shown) additionally revealed partial tear of the anterior talofibular ligament. Learning objectives for this will include reviewing foot anatomy, x-ray evaluation, mechanisms of injury. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-48277. Bone marrow edema as a result of avulsion fracture at the talar attachment of the deep tibiotalar component of the deltoid ligament is an uncommon cause of medial talar . The talus, the second largest tarsal bone, has distinctive imaging characteristics and injury patterns. Often they are seen in only one of the frontal or oblique views. Often they are seen in only one of the frontal or oblique views. Talus Fractures. Copercini M, Bonvin F, Martinoli C et-al. Lateral. Fig. Fractures of the lateral process of the talus are common in snowboarding injuries about the foot and ankle, accounting for about 15% of snowboarding injuries in this region (Egol et al. 1. 5. ISBN:B0040SYP2C. As many as 40-50% of fractures are missed on radiographs due to overlapping osseous structures 2. Sanders et al.'s [13] original description of intraarticular calcaneal fracture classification was based on coronal and axial CT cross-sections with the widest undersurface of the posterior facet of the talus (Fig. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Goofit P, Avulsion fractures of talus and calcaneus. Lateral talar process fracturesor snowboarder fractures are talusfractures that can mimic a lateral ankle sprain. There are small avulsion fractures of the lateral process of talus and the anterior process of calcaneus. In addition, the lack of muscular attachments and absence of a secondary blood supply can lead to subsequent osteonecrosis. 2010d). Unable to process the form. Lateral ankle soft tissue swelling. 2b: >2 mm displacement of fracture fragments; grade 3: cortical avulsion fracture; MRI. ADVERTISEMENT: Supporters see fewer/no ads. The anterior inferior tibiofibular ligament and the calcaneofibular ligament show normal echopattern. An improved AP image has also been described in which the foot is pronated 15 degrees and the x-ray beam angled 75 degrees from table. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Lee P, Hunter TB, Taljanovic M. Musculoskeletal colloquialisms: how did we come up with these names?. You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. Less frequently it leads to an avulsion of the anterolateral tibial epiphysis. Type 1 is simple avulsion with variable sized bone fragment, type 2 is beak fracture with horizontal fracture extending into posterior body, type 3 is avulsion by superficial fibers of middle third of Achilles tendon, and type 4 is small beak fracture avulsed from deep fibers of tendon. I or related party have no financial relationship to disclose. Ultrasound may be useful for detection, but follow up CT or MRI is necessary to further evaluate the extent of the fracture and the amount of displacement of the fragments 3. c Axial T2-weighted fat-suppressed image shows . talar head fractures; talar neck fractures; talar body fractures. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-95495. Talar fractures are an uncommon injury, accounting for <5% of all foot fractures. There are small avulsion fractures of the lateral process of talus and the anterior process of calcaneus. Although talar fractures account for less . The fracture may sometimes be difficult to identify on radiographs and CT may be necessary to identify the fracture line. Figure 2: (2A) Lateral radiograph of the foot demonstrates a mildly displaced avulsion fracture from the dorsal talar head (arrow). Radiographics. Canale ST, Beaty JH. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Morgan M, Hacking C, Hacking C, et al. Failure to detect the fracture may lead to non-union,ankle instability, and accelerated osteoarthritis. We will spend a time to discuss base of fifth fractures, stress fractures and sesamoid pathology. 10, 11 Like other talar fractures, they occur when a person falls from a . ADVERTISEMENT: Supporters see fewer/no ads. Pathology Location. 2 Classification for calcaneal avulsion fractures. ADVERTISEMENT: Supporters see fewer/no ads. 1. This mechanism of injury accounts for the fact that the 56.3% of talar dome fractures are found on the posterior medial aspect of the talar dome. Either is acceptable. The lateral talar process is one of the check areas on an ankle series for any patient with lateral pain. Check for errors and try again. Because the talus is important for ankle movement, a fracture often results in substantial loss of motion and function. Talar fractures. No bony avulsion from the tibia/ talus. 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