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So here we have a 21-year-old male

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after snowboarding injury, three projections of the ankle,

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the ap, the oblique or mortis view,

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and the lateral projection.

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And we look carefully.

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We identify that there is a lucency through that part

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of the tailless.

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This person had gone on to MRI

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and we can see disruption of the lateral process

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of the tails with associated bone mar edema pattern here.

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Better appreciated on the sagittal sections.

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So lateral sections along the ankle show

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that triangular configuration of that

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lateral process fracture.

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So then if we go back on the radiograph,

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we can see the correlate with the lateral process fracture

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on the lateral projection.

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So here's the diagram of of the tailless,

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and we can think of the the Taylor head, the neck, the

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posterior process, and the lateral process.

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So lateral process fractures.

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The typical mechanism is dorsiflexion inversion

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with an axial load or external rotation.

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And so this is characteristically seen

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as a snowboarders fracture.

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So with this inversion injury, it can be AULs

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with an aversion injury or snowboarders fracture.

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They often have a worse prognosis

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because it could be communed and crushing.

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As we saw on the cross-sectional imaging,

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they're commonly missed on radiography.

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So you need to have a high index of suspicion,

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but also include that lateral process as part

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of your checklist for looking at ankle

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radiographs in the setting of trauma.

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So these are frequently missed on x-ray

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and the patient returns with persistent pain

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after an ankle sprain.

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So for every ankle injury we're gonna include

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this as part of our checklist.

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So at the lateral process there is a ligamentous attachment

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of the lateral tail calcaneal ligament.

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Anatomically the lateral process separates the neck

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fractures from the body fractures,

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so body fractures are more posterior.

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And so when considering tailor fractures,

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we can look at the anatomy.

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Consider fracture patterns involving the neck,

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body and processes.

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Typically the lateral process or the posterior process.

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So the blood supply of the tail list comes

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in through the neck.

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There's a posterior tibial artery

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that has calcaneal branches.

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There's an artery of the tarsal canal.

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There's a deltoid branch.

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There's also supply from the dorsalis PDUs,

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which gives you the medial tarsal artery

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and the artery of the tarsal sinus.

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And there's a perineal artery which has anastomotic branches

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as the artery of the tarsal sinus and calcaneal branches.

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So when we talk about tailored neck fractures,

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we can use the Hawkins classification system.

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So type one is a non-displaced fracture.

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Shown here has a lower risk of

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Osteonecrosis, typically less than 30%.

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Type two. In addition to the Taylor neck fracture,

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their subluxation of the sub Taylor joint here,

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the osteonecrosis rate is a bit higher, somewhere between 20

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and 50% Type three.

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In addition to the Taylor neck fracture

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and subluxation of the sub Taylor joint,

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there's also subluxation of the ankle joint.

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And here the osteonecrosis rate is very high, somewhere

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between 75 to a hundred percent.

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Type four has not only a Taylor neck fracture,

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but subluxation of the sub taylor joint, the ankle joint,

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and the tail navicular joint.

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And here we have a near a hundred percent

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osteonecrosis complication rate.

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So with these Taylor injuries, it's important to

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recognize the injury, study the radiographs, and assess.

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Is there a subtalar dislocation by itself

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or is this something associated with a Taylor neck fracture?

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So for the Taylor body, the fractures are defined

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as posterior to the lateral process.

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They occur about 70 40% of the time.

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The mechanism is a hyper dorsiflexion and axial loading the.