Management and classification of the fracture of lateral process of talus: An overview and literature update

Table 1 Summary table of prognoses of the included studies

Ref.	Sample size	Classification	Treatments	Prognoses	Remarks regarding prognoses
Hawkins[15], 1965	13	Hawkins type 1: 6; Hawkins type 2: 5; Hawkins type 3: 2	All patients were treated conservatively as the initial treatment	7 patients returned to normal motion without pain or limp. The remaining 6 had residual pain and/or limited motion and underwent subsequent fragments resection or joint fusion surgery, and ultimately 3 still had residual localized pain and mild limitation of movement	In Hawkins' day, the prognosis for conservatively treated patients was not that bad
von Winning et al[30], 2020[30]	8	All classified as McCrory-Bladin type 2	ORIF with cannulated screws	All fractures healed completely; Mean AOFAS score was 81.4, mean FFI was 19.4, mean physical component summary score was 48.9, and mean mental component summary score was 51.9	Delayed surgical managements did not significantly lead to a poor prognosis
Hörterer et al[6], 2019	22	Hawkins type 1: 16; Hawkins type 2: 5; Hawkins type 3: 1	ORIF: type 1; Fragments resection: type 2 and type 3	2 patients suffered minor surgical side infections. 12 patients developed symptomatic subtalar osteoarthritis, with no significant difference between types 1 and 2 fractures. Only 50% of the patients returned to the previous level of sports	The occurrence of secondary subtalar arthritis after ORIF and fragments resection was the same
Wijers et al[25], 2020	36	Wijers type 1A: 1; Wijers type 1B: 6; Wijers type 2: 10; Wijers type 3: 11; Wijers type 4A: 6; Wijers type 4B: 2	Conservative: 8; ORIF: 26; Subtalar joint fusion: 2	18 people were effectively followed up. The median AOFAS hindfoot score was 75 (range: 12-100) points. The median FFI score was 2 (range: 0-9) points. 3 (17%) patients had an excellent result, 8 (44%) patients had a good result, 5 (28%) patients had a fair result, and only 2 (11%) patients had a poor outcome	Patients who received timely and accurate managements were more likely to obtain a satisfactory prognosis
Ross et al[10], 2021	53	McCrory-Bladin type 1: 7; McCrory-Bladin type 2: 23; McCrory-Bladin type 3: 23	Conservative treatment was performed for 21 patients as the initial treatment to, of whom 14 underwent second surgery of fragments resection or subtalar joint fusion; ORIF was performed for 32 patients as the initial treatment.	For those whose initial treatments were conservative, PROMIS PF score was 53, FAAM-ADL was 88, FAAM-S was 75. There was no difference in the above indicators between patients who had or had not undergone second surgery. For those whose initial treatments were ORIF, PROMIS PF score was 56, FAAM-ADL was 90; FAAM-S was 77	Long-term prognoses were closely related to fracture displacement, but less so to fragment size, subtalar joint compression injury, and treatment method. However, the rate of subsequent talar arthrodesis was higher in initial conservative treatment group
Wang et al[26], 2023	43	Zhang's type 1a: 2; Zhang's type 1b: 1; Zhang's type 1c: 2; Zhang's type 2a: 1; Zhang's type 2b: 6; Zhang's type 2c: 18; Zhang's type 2d: 3; Zhang's type 2e: 10	Conservative: 3; ORIF: 39; Fragments resection: 1	AOFAS score: Zhang's type 1a: 91.5; Zhang's type 1b: 86.0; Zhang's type 1c: 90.5; Zhang's type 2a: 89.0; Zhang's type 2b: 76.7; Zhang's type 2c: 76.6; Zhang's type 2d: 91.3; Zhang's type 2e: 83.5. Complications including nonunion and arthritis were observed in only 7 (16.3%) cases	Prognoses of FLPT were related to simultaneous injuries of other parts of ipsilateral talus
Feng et al[28], 2023	42	All fractures were classified as McCrory-Bladin type 3	Arthroscopic internal fixation was performed for 24 cases by using a Double-pully technique combined with Kirschner wire. Open reduction and Kirschner wire fixation were performed for 18 patients	Among the patients treated arthroscopically, only 2 (8.3%) developed subtalar arthritis, with the primary symptoms being local pain and discomfort after exercising that was relieved by taking rest. After 12 months of surgery, the mean PROMIS PF score was 71.6, mean AOFAS score was 94.0, mean FAAM-ADL was 92.5, and mean FAAM-S was 94.4. Among those who underwent open reduction and Kirschner wire fixation, 6 (33.3%) patients developed subtalar arthritis. Consequently, 3 of them underwent a second surgery of subtalar joint fusion. After 12 months of surgery, the mean PROMIS PF score was 62.9, mean AOFAS score was 77.9, mean FAAM-ADL score was 72.1, and mean FAAM-S score was 78.6	Arthroscopic-assisted surgery can help improve the prognoses of FLPT
Feng et al[29], 2023	33	All fractures were classified as McCrory-Bladin type 2	21 patients were treated with double-tunnel subtalar arthroscopy combined with hollow compression screw internal fixation. The other 12 patients were treated with ORIF with hollow compression screw	For patients treated arthroscopically, no obvious complication was found. At the final follow-up, the mean AOFAS score was 95.8, mean FFI score was 12.3, mean FAAM-ADL score was 92.7, and mean FAAM-S score was 95.6. Among those who underwent ORIF with hollow compression screw, 2 (16.7%) patients developed local skin numbness associated with nerve injury. At the last follow-up, the mean AOFAS score was 94.8, mean FFI score was 14.4, mean FAAM-ADL score was 89.8, and mean FAAM-S score was 93.6	For McCrory-Bladin type 2 FLPT, the use of compression screw internal fixation could achieve reliable results. However, compared to open surgery, arthroscopy procedure obtained mini trauma and better functions
Mui et al[31], 2020	1 delayed case	Not mentioned	ORIF with 2 headless compression screw, followed by an iliac autologous bone graft procedure and anterior talofibular ligament reconstruction with 2 suture anchors	An overgrowth of the tip of the lateral talar process led to pain while snowboarding. After 1 yr of the second surgery of the enlarged part excision, the patient returned to his previous level of motion without pain	Delayed FLPT cases can also lead to good long-term prognosis
Killen et al[32], 2018	2 delayed cases	Not mentioned	ORIF with a headless compression screw and anterior talofibular ligament reconstruction with a suture anchor	At 12 months after surgery, the mean AOFAS score was 90. Both patients regained recovery of full, activity without any residual pain or symptoms of instability	Delayed FLPT cases can also lead to good long-term prognosis

ORIF: Open reduction and internal fixation; AOFAS: American Orthopedic Foot and Ankle Society; FFI: Foot Function Index; FLPT: Fracture of the lateral process of the talus; PROMIS PF: Patient-reported outcomes measurement information system physical function; FAAM-ADL: Foot and ankle ability measure-activities of daily living; FAAM-S: Foot and ankle ability measure-sports.