Rogosić Srdan, Bojanić Ivan, Borić Igor, Tudor Anton, Srdoc Dubravka, Sestan Branko
Department of Orthopedic Surgery, Zagreb University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2010 Sep;49(3):315-20.
In this report, we present a rare case of an initially unrecognized fracture of the posteromedial process of the talus sustained in a seldom reported position of dorsiflexion and supination of the foot. Fractures of the posteromedial process of the talus are very rare and represent an important diagnostic problem. Difficult x-ray visualization makes these fractures often misdiagnosed as ankle sprains. Complications due to this kind of fractures can include serious consequences such as avascular osteonecrosis, tarsal tunnel syndrome, post-traumatic osteoarthritis, or chronic pain. Timely diagnosis represents an important factor in the development of these conditions. A heightened awareness in examining ankle traumas with specific patient history details is of great importance. The most common mechanism of injury includes dorsiflexion and pronation of the foot. However, in an increasing number of cases alternative mechanisms have been described, all including high-energy impacts. Our patient sustained a fracture of the posteromedial process of the talus in dorsiflexion and supination with high-energy impact due to a 3-m fall. The patient was treated with excision of the fragment six months after the injury, and 18 months after the surgery the patient returned to his normal daily activities with significantly less pain in the posteromedial part of the ankle.
在本报告中，我们呈现了一例罕见病例，患者为距骨后内侧突骨折，最初未被识别，受伤时足部处于很少报道的背屈和旋后位。距骨后内侧突骨折非常罕见，是一个重要的诊断难题。X线难以清晰显示，常导致这些骨折被误诊为踝关节扭伤。此类骨折的并发症可能包括严重后果，如缺血性骨坏死、跗管综合征、创伤后骨关节炎或慢性疼痛。及时诊断是这些病症发展的重要因素。结合特定患者病史细节对踝关节创伤进行检查时提高警惕非常重要。最常见的损伤机制包括足部背屈和旋前。然而，越来越多病例描述了其他损伤机制，均包括高能撞击。我们的患者因3米高处坠落导致足部在背屈和旋后位时受到高能撞击，发生距骨后内侧突骨折。患者在受伤6个月后接受了骨折碎片切除术，术后18个月患者恢复了正常日常活动，踝关节后内侧疼痛明显减轻。
