Snowboarder's ankle

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Classification according to ICD-10
S92.1 Fracture of the talus
ICD-10 online (WHO version 2019)
Anatomy of the talus (left leg) with a plan view of the lateral process

Snowboarder's ankle describes a special bone fracture of the ankle bone that was rarely diagnosed in the past and has increased in frequency with the spread of snowboarding in winter sports. This affects the lateral process tali, an extension of the talus, which faces outwards and a portion of the articulation with the lateral malleolus of the fibula and down to the heel bone forms.

Concept formation

An early description of the fracture of the lateral processus tali can be found as early as 1965, but not yet in connection with snowboarding. With the increasing frequency of injuries in snowboarding, these have also been scientifically investigated more systematically - often in comparison with typical injuries in skiers . With the awareness that it was a typical injury for snowboarders, the term snowboarder's fracture was first coined, later the term snowboarder's ankle was added. In contrast to the German translation, ankle , the English term ankle includes the ankle bone.

Snowboarders ankle - Roe ap.jpg
Snowboarders ankle - CT coronar.jpg
coronary
Snowboarders ankle - CT sagittal.jpg
sagittal


X-ray and computed tomography on snowboarder's ankle right leg

Emergence

In snowboarding, the injury typically occurs when landing after a jump on an uneven surface, with the question of a connection between the type of snowboard boot and the probability of a fracture at the lateral process being answered differently. Since beginners usually don't jump with the board yet, the fracture is more of an injury to the more advanced snowboarder.

The exact mechanism of the accident is given as a combination of dorsiflexion, axial compression and, depending on the source, external rotation, supination or pronation . For this purpose, tests were carried out on cadaver legs, among other things.

Another sport where the break has been described is wakeboarding . The same pattern of injuries can occur in other accidents with a stretched leg and axial compression (e.g. braking attempt with a subsequent rear-end collision).

Clinic and diagnostics

The injury presents with pain and swelling in the tarsus and outside of the foot. These findings can easily be mistaken for a sprain , strain, or torn ligament on the outer ankle. Especially if it is not known that he is a snowboarder. Also, the broken bone is sometimes difficult to see on overview x-rays. Computed tomography can show the fault lines without overlaying them and is helpful for planning the right therapy.

Fracture types

Classification of fractures of the lateral process according to McCrory / Bladin

Depending on how the individual fault lines run and how large the fragments are, different treatment should be sought. A classification into three different fracture types was proposed as early as 1965. The classification used today comes from McCrory and Bladin (1996):

  • Type I: Small fragment at the tip of the lateral process without articular involvement.
  • Type II: A larger fragment with involvement of the articular surfaces to the outer malleolus and caudally to the calcaneus . This type can be surgically screwed.
  • Type III: Debris fracture with many small fragments.

treatment

Treatment options depend on the type of fracture. If the outer fragment is large enough (over 1 cm, McCrory-Bladin Type II), surgical refixation with mini-fragment screws can be carried out, even if the dislocation is only minor. Such a re-fixation seems to have an advantage for the patient compared to the conservative treatment. However, removing small fragments under 1 cm (type I) or debris from a type III fracture from the joint area can also lead to a better result if refixation is not possible. Conservative therapy should be carried out with a plaster immobilization in a slight equinus foot position, but it is prone to complications and is mainly recommended for patients who are contraindicated to an operation, as it often leads to painful pseudarthrosis , which is then secondary to excision or even makes subtalar arthrodesis necessary.

Individual evidence

  1. ↑ P. Langer, C. DiGiovanni: Incidence and pattern types of fractures of the lateral process of the talus.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 156 kB)@1@ 2Template: Dead Link / www.amjorthopedics.com   In: American journal of orthopedics (Belle Mead, NJ). Volume 37, Number 5, May 2008, pp. 257-258, ISSN  1934-3418 . PMID 18587503 .
  2. ↑ a b c L. G. Hawkins: Fracture of the lateral process of the talus. In: The Journal of bone and joint surgery. American volume. Volume 47, September 1965, pp. 1170-1175, ISSN  0021-9355 . PMID 14337775 .
  3. ^ EC Pino, MR Colville: Snowboard injuries. In: The American journal of sports medicine. Volume 17, Number 6, 1989 Nov-Dec, pp. 778-781, ISSN  0363-5465 . PMID 2624290 .
  4. ^ R. Nicholas, J. Hadley, C. Paul, P. James: "Snowboarder's fracture": fracture of the lateral process of the talus. In: The Journal of the American Board of Family Practice / American Board of Family Practice. Volume 7, Number 2, 1994 Mar-Apr, pp. 130-133, ISSN  0893-8652 . PMID 8184703 . (Review).
  5. ^ A b P. McCrory, C. Bladin: Fractures of the lateral process of the talus: a clinical review. "Snowboarder's ankle". In: Clinical Journal of Sport Medicine. Volume 6, Number 2, April 1996, pp. 124-128, ISSN  1050-642X . PMID 8673570 . (Review).
  6. ^ A b C. C. Young, MW Niedfeldt: Snowboarding injuries. In: American family physician. Volume 59, Number 1, January 1999, pp. 131-6, 141, ISSN  0002-838X . PMID 9917579 . (Review).
  7. ↑ a b A. Imhoff, R. Linke, R. Baumgartner: Checklist Orthopädie in Georg Thieme Verlag, 2nd edition 2011, ISBN 978-3-13-1422828
  8. ^ DP Kirkpatrick, RE Hunter, PC Janes, J. Mastrangelo, RA Nicholas: The snowboarder's foot and ankle. In: The American journal of sports medicine. Volume 26, Number 2, 1998 Mar-Apr, pp. 271-277, ISSN  0363-5465 . PMID 9548123 .
  9. ↑ JR Funk, SC Srinivasan, JR Crandall: Snowboarder's talus fractures experimentally produced by eversion and dorsiflexion. In: The American journal of sports medicine. Volume 31, Number 6, 2003 Nov-Dec, pp. 921-928, ISSN  0363-5465 . PMID 14623658 .
  10. ^ AJ Boon, J. Smith, ME Zobitz, KM Amrami: Snowboarder's talus fracture. Mechanism of injury. In: The American journal of sports medicine. Volume 29, Number 3, 2001 May-Jun, pp. 333-338, ISSN  0363-5465 . PMID 11394605 .
  11. ↑ J. Grifka: Practical knowledge retention and movement organs - Sports Injuries - Sports damage in Georg Thieme Verlag, Stuttgart, 2005, ISBN 3-13-140041-2
  12. ↑ a b D. Porter: Baxter's The Foot and Ankle in Sport Mosby 2008 ISBN 978-0323023580
  13. ↑ SE Mussmann, JN Poirier: snowboarder's fracture Caused by a wakeboarding injury: a case report. In: Journal of chiropractic medicine. Volume 9, Number 4, December 2010, pp. 174-178, ISSN  1556-3715 . doi : 10.1016 / j.jcm.2010.08.001 . PMID 22027109 . PMC 3206565 (free full text).
  14. ↑ "Snowboarder's ankle" may be mistaken for sprain at http://www.reuters.com/
  15. ^ V. Valderrabano, T. Perren, C. Ryf, P. Rillmann, B. Hintermann: Snowboarder's talus fracture: treatment outcome of 20 cases after 3.5 years. In: The American journal of sports medicine. Volume 33, Number 6, June 2005, pp. 871-880, ISSN  0363-5465 . doi : 10.1177 / 0363546504271001 . PMID 15827363 .
  16. ^ SJ Parsons: Relation between the occurrence of bony union and outcome for fractures of the lateral process of the talus: a case report and analysis of published reports. In: British journal of sports medicine. Volume 37, Number 3, June 2003, pp. 274-276, ISSN  0306-3674 . PMID 12782558 . PMC 1724631 (free full text). (Review).
  17. ↑ Bernhard Weigel, Michael Nerlich: Praxisbuch Unfallchirurgie Springer-Verlag Heidelberg 2005 (Volume 1, p. 794; ISBN 3-540-41115-1 )

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