Fracture of the Lateral Process of the Talus in Children: A Kind of Ankle Injury With Frequently Missed Diagnosis.

OBJECTIVE: To analyze the clinical characteristics, the treatment, and the outcome of lateral process fracture of the talus in children.

METHODS: From March 2011 to October 2013, 12 children with lateral process fracture of the talus were treated in our hospital. The study contained 3 female and 9 male patients, including 8 patients affected on the left side and 4 on the right side. The age at the time of injury ranged from 8 to 13 years. Concomitant injuries included undisplaced calcaneus fractures in 1 case and distal fibula epiphysis injury in 1 case. The patients presented to our hospital from 2 hours to 2 months after injury. All cases were classified by the Hawkins fracture system. Treatment included immobilization and not bearing weight for 4 weeks for nondisplaced fractures or open reduction and fixation for significantly displaced fractures. Therapeutic effects were evaluated on the basis of the AOFAS (The American Orthopaedic Foot and Ankle Society) Ankle Hindfoot Scale.

RESULTS: Seven of the cases were initially diagnosed in our department, and the diagnosis was missed in 5 cases. The missed diagnosis rate was 42%. All patients were followed up for 18 months on an average. Follow-up radiographs did not show avascular necrosis of the talus, nonunion, and malunion in any patient. The mean AOFAS hindfoot score was 96 points. The clinical result was found to be excellent in 10 patients, good in 1 patient, and fair in 1 patient (the success rate was 92%).

CONCLUSIONS: The lateral process of talus fracture is a frequently missed injury. The diagnosis must rely on thorough check-ups combined with standard radiographs and computed tomographic scan. Depending on the type and the displacement of the fracture, proper treatment options could be implemented for desirable clinical effects.