However, little clinical evidence has yet been provided. demonstrated that all the specimens subjected to eversion force sustained LTPF. But with additional external rotation, six out of eight specimens sustained LTPF. failed to create LTPF with a combined force of axial loading, dorsiflexion, and inversion. In a previous cadaveric study, Boon et al. However, some authors proposed that LTPF could also be a result of an eversion or external rotation force toward the foot. This theory provided further evidence that that LTPF could occur with concomitant lateral ligaments injury. Therefore, an inversion force could cause overstretching of the lateral talocalcaneal ligament, tearing the lateral process from the talus. The anatomical basis of the inversion mechanism is that the talofibular and talocalcaneal ligaments terminate in the lateral process of the talus. Early reports suggested that LTPF and ankle sprain shared similar symptoms and injury mechanism, namely forced inversion of the foot. However, the injury mechanism of LTPF remains unclear. Once a rare injury, LTPF has recently been on the rise with the popularity of snowboarding. In this study, we describe 2 cases of LTPF with associated deltoid ligament injury, which provides indirect evidence on the possibility of the eversion/external rotation injury mechanism. To our knowledge, little clinical evidence has been provided to support this injury mechanism. However, some cadaveric biomechanical studies proposed that LTPFs could also be caused by dorsiflexion of the foot with associated eversion or external rotation. In some cases, the calcaneofibular ligaments have also been reported to be ruptured. The mechanism of this injury is traditionally presumed to be forced dorsiflexion of the foot with associated inversion that lead to avulsion fracture of the lateral process of the talus. Most LTPF are isolated fractures and only rarely are associated ligamentous injuries. Of all fractures, 0.1–0.85% are talar fractures and only 10.4–20% of these involve the lateral process. These two cases provided clinical evidence that eversion or external rotation force, in addition to inversion, was also an important mechanism of LTPF.įractures of the lateral process of the talus (LTPF), also known as “snowboarder’s ankle”, are very rare in the general population. There are many possibilities of the injury mechanism of LTPF. Both patients achieved excellent clinical outcomes 1 year post injury. Treatment included fixation of the lateral process of the talus with headless compression screws and repair of deltoid ligaments. Surgical exploration revealed rupture of the superficial layer of the deltoid ligaments with intact deep layer in both patients. Plain radiographs and computed tomography revealed LTPF and medial soft tissue swelling, and magnetic resonance imaging confirmed a discontinuity of the deltoid ligament in Case 1. Physical examination revealed tenderness and swelling on both medial and lateral sides of the ankles. Two patients presented to the emergency department with ankle pain after ankle eversion or external rotation. But no clinical evidence has been provided. However, previous cadaveric studies have suggested that LTPF was more likely to be caused by eversion or external rotation force with dorsiflexion of the ankle. The injury mechanism is commonly considered to be similar with ankle sprains, where excessive varus of the hindfoot leads to avulsion fractures of the lateral process of the talus. Fractures of the lateral process of the talus (LTPF) are rare and only rarely are associated ligamentous injuries.
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