MetroHealth Medical Center, Cleveland, OH.
Harborview Medical Center, Seattle, WA.
J Orthop Trauma. 2018 Dec;32(12):601-606. doi: 10.1097/BOT.0000000000001326.
To determine whether fracture of the lateral process (LP) elevates the risk of development of radiographic subtalar arthrosis in patients with talar body and neck fractures.
Retrospective review.
Level 1 academic trauma center.
PATIENTS/PARTICIPANTS: Eighty-two patients with 43 talar neck and 43 talar body fractures treated over a 5-year period.
Preoperative and postoperative radiographs were evaluated for fracture of the LP of the talus and subsequent development of radiographic subtalar arthritis.
Radiographic evidence of subtalar arthritis.
Seventy-six percent of talar neck fractures with involvement of the LP went on to develop radiographic evidence of subtalar arthrosis compared with 36% of talar neck fractures without LP involvement (P = 0.035). Thirty of the fractures involving the LP had a separate LP fragment. Fifteen of the 30 fractures with a separate LP fragment that underwent reduction and fixation developed radiographic evidence of subtalar arthrosis, whereas all 13 fractures with an independent LP fragment that did not have fixation of the LP went on to develop radiographic evidence of subtalar arthritis (P = 0.001). Comminution of the inferior talar articular surface was found to significantly increase the risk of radiographic subtalar arthritis in both talar body and talar neck fractures (P = 0.0003). An anatomic reduction of both talar neck and body fractures was found to be associated with a lower incidence of radiographic subtalar arthritis (P = 0.00001).
Comminution of the inferior articular surface of the talus elevates the risk of subtalar arthritis in patients with both talar neck and body fractures. Fracture of the LP is a marker for injury to the talar inferior articular surface and increases the risk for the radiographic finding of subtalar arthritis in patients with talar neck fractures.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定外侧突骨折（LP）是否会增加距骨体和颈骨折患者发生放射照相性距下关节炎的风险。
回顾性研究。
1 级学术创伤中心。
患者/参与者：5 年内治疗的 43 例距骨颈骨折和 43 例距骨体骨折患者，共 82 例。
评估距骨 LP 的术前和术后 X 线片，并随后评估放射照相性距下关节炎的发展情况。
距下关节炎的放射照相证据。
76%累及 LP 的距骨颈骨折发展为放射照相性距下关节炎，而无 LP 受累的距骨颈骨折为 36%（P = 0.035）。30 例 LP 骨折中有单独的 LP 碎片。在接受复位和固定治疗的 30 例有单独 LP 碎片的骨折中，有 15 例发展为放射照相性距下关节炎，而所有 13 例无 LP 固定的独立 LP 碎片骨折均发展为放射照相性距下关节炎（P = 0.001）。发现距骨下关节面粉碎明显增加距骨体和距骨颈骨折的放射照相性距下关节炎风险（P = 0.0003）。发现距骨颈和体骨折的解剖复位与放射照相性距下关节炎的发生率较低相关（P = 0.00001）。
距骨下关节面粉碎增加了距骨颈和体骨折患者发生距下关节炎的风险。LP 骨折是距骨下关节面损伤的标志物，并增加了距骨颈骨折患者发生放射照相性距下关节炎的风险。
预后 III 级。有关证据水平的完整描述，请参阅作者说明。
