Rodop Osman, Mahiroğulları Mahir, Akyüz Mustafa, Sönmez Güner, Turgut Hasan, Kuşkucu Mesih
GATA Haydarpaşa Training Hospital, Department of Orthopedics, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2010;44(5):392-6. doi: 10.3944/AOTT.2010.2328.
Thirty-nine percent of the ankle and midfoot fractures in ankle distortions could be missed during initial evaluation in emergency department because of inadequate clinical and radiological evaluation in a limited time. We aimed to evaluate the follow-up and treatment outcomes of subjects with missed fractures, which were not diagnosed with plain radiographs obtained for ankle distortion, but with advanced imaging studies.
Eight patients (4 females, 4 males) who were initially treated with a diagnosis of ankle distortion due to trauma between 2004 and 2008 were included in the study. Since there were no fractures in the initial radiographs reported by radiologists, conservative treatment was applied. However, the pain and swelling around the ankle were sustained and advanced imaging studies revealed talus fracture. All patients were evaluated with the scoring system of American Orthopedic Foot and Ankle Society (AOFAS).
Mean age of the patients was 22.37 years (range 20-40 years) at the initial fracture diagnosis. The talar neck fracture was diagnosed with computed tomography (CT) in 1 patient and with magnetic resonance imaging (MRI) in the remaining 7 patients. Mean follow-up time was 6 months (range 3-8 months), and mean AOFAS score at last follow-up was 93.7 (range 80-100).
Talus fractures can lead to serious complications because of its anatomical localization. Areas with edema, tenderness or pain should be defined on physical examination, and deep palpation should be applied on the lateral aspect of the talar neck. If there is pain in this area at late examination and no fracture was reported with conventional radiographs, the possibility of missed talar fracture should be considered and the patient should be evaluated with CT or MRI.
在急诊室进行初步评估时，由于在有限时间内临床和影像学评估不足，踝关节扭伤中39%的踝关节和中足骨折可能会被漏诊。我们旨在评估漏诊骨折患者的随访情况和治疗结果，这些患者最初通过踝关节扭伤的X线平片未诊断出骨折，但通过先进的影像学检查得以确诊。
纳入8例在2004年至2008年期间因创伤最初被诊断为踝关节扭伤的患者（4例女性，4例男性）。由于放射科医生报告的初始X线平片中未发现骨折，因此采取了保守治疗。然而，踝关节周围的疼痛和肿胀持续存在，先进的影像学检查显示距骨骨折。所有患者均采用美国矫形足踝协会（AOFAS）评分系统进行评估。
最初骨折诊断时患者的平均年龄为22.37岁（范围20 - 40岁）。1例患者通过计算机断层扫描（CT）诊断为距骨颈骨折，其余7例患者通过磁共振成像（MRI）诊断。平均随访时间为6个月（范围3 - 8个月），末次随访时AOFAS平均评分为93.7（范围80 - 100）。
由于距骨的解剖位置，距骨骨折可导致严重并发症。体格检查时应明确水肿、压痛或疼痛区域，并对距骨颈外侧进行深部触诊。如果后期检查该区域有疼痛且常规X线平片未报告骨折，则应考虑距骨骨折漏诊的可能性，并对患者进行CT或MRI评估。
