Department of Orhopaedic Surgery, Muir Orthopaedic, Specialists, Walnut, Creek, CA 94598, USA.
J Am Acad Orthop Surg. 2009 Dec;17(12):775-86. doi: 10.5435/00124635-200912000-00006.
Because of the effect on hindfoot kinematics, missed or delayed diagnosis of peritalar injuries often results in impairment. The seemingly innocuous nature of these injuries, subtle radiographic findings, and low incidence limit familiarity, thereby increasing the likelihood of misdiagnosis. Because of delay in diagnosis, salvage arthrodesis may be necessary to restore function to the extremity. Talar head fracture, talar process fracture, subtalar fracture-dislocation, transverse tarsal joint fracture, and transverse tarsal ligamentous disruption with instability are recurrently misdiagnosed. The keys to proper diagnosis of these potentially devastating injuries are the recognition of their existence, their injury patterns, and their radiographic appearance. The threshold for additional imaging studies should be lowered when a patient has pain and physical examination findings are out of proportion to a provisional diagnosis, or when symptoms fail to improve.
由于后足运动学的影响，跗骨间损伤的漏诊或误诊常常导致功能障碍。这些损伤看似无害，影像学表现细微，发病率低，导致人们不熟悉，从而增加了误诊的可能性。由于诊断延迟，可能需要进行跗骨融合术来恢复肢体的功能。距骨头部骨折、距骨突骨折、距下关节骨折脱位、跗横关节骨折和伴有不稳定的跗横韧带断裂经常被误诊。正确诊断这些潜在破坏性损伤的关键是认识到它们的存在、它们的损伤模式和它们的影像学表现。当患者出现疼痛且体格检查结果与初步诊断不成比例，或者症状没有改善时，应降低进一步影像学检查的阈值。
