What is the treatment guideline for a mildly displaced fracture through the lateral process of the talus?

Treatment of Mildly Displaced Lateral Process Talus Fracture

Mildly displaced lateral process fractures of the talus should be treated with open reduction and internal fixation (ORIF) to optimize outcomes and prevent long-term complications. 1, 2

Diagnostic Approach

• Initial evaluation should include standard ankle radiographs
• CT is the first-line advanced imaging modality after radiographs to determine:
  • Extent of displacement
  • Comminution
  • Intra-articular extension
  • Associated injuries 3
• Broden's view (supine flexed knee with 30-45° internal rotation) may help evaluate lateral process fractures specifically 3
• MRI is useful for assessing associated soft tissue injuries and bone marrow contusions 3

Classification and Treatment Algorithm

Type 1: Small, Minimally Displaced Fractures

• Treatment: ORIF for optimal outcomes 1
• Small fragments (<1cm) that are minimally displaced should be fixed with screws or K-wires
• Rationale: Even small fragments can lead to subtalar joint instability and post-traumatic arthritis if not properly reduced

Type 2: Moderately Displaced Fractures

• Treatment: ORIF with screws or plate fixation 2
• Anatomic reduction is critical for articular congruity
• Careful surgical exposure to protect surrounding neurovascular structures

Type 3: Severely Comminuted Fractures

• Treatment: Fragment excision if too small for fixation, followed by early mobilization
• Consider primary arthrodesis in cases with severe articular damage

Surgical Technique

1. Lateral approach to the ankle
2. Careful dissection to expose the fracture site
3. Anatomic reduction of articular fragments
4. Stable fixation with appropriate hardware
5. Intraoperative assessment of subtalar joint stability

Postoperative Management

• Non-weight bearing for 4-6 weeks in a short leg cast or boot
• Progressive weight bearing starting at 6 weeks based on radiographic healing
• Range of motion exercises to prevent stiffness
• Return to full activities at 12-16 weeks based on clinical and radiographic healing

Outcomes and Prognosis

• Early surgical treatment of displaced fractures leads to better functional outcomes 4
• Patients treated with early surgery have significantly fewer subtalar fusions compared to nonoperative management 4
• Patient-reported outcomes after proper treatment show good to excellent results in most cases 4
• Mean PROMIS Physical Function scores of 55 and FAAM scores of 89 for ADL and 77 for sport can be expected 4

Complications to Monitor

• Subtalar arthritis (occurs in up to 73% of cases) 5
• Talar necrosis (occurs in up to 39% of cases) 5
• Nonunion or malunion
• Persistent pain and functional limitation

Important Considerations

• Missed or delayed diagnosis significantly increases morbidity 1
• Conservative treatment should only be considered for truly non-displaced, extra-articular fractures 2
• Failed nonoperative management is common (67%) in displaced fractures 4
• Late presenting fractures that are not united should be excised if small and internally fixed if large 1

The evidence strongly supports surgical management for mildly displaced lateral process talus fractures to restore anatomic alignment, prevent arthritis, and optimize functional outcomes.