Bellapianta Joseph M, Andrews James R, Ostrander Roger V
Plancher Orthopaedics and Sports Medicine, Cos Cob, CT 06907, USA.
J Foot Ankle Surg. 2011 Jul-Aug;50(4):462-5. doi: 10.1053/j.jfas.2011.03.016. Epub 2011 May 14.
An os subtibiale is an accessory bone separated from the distal medial tibia proper. Subtalar tarsal coalition is a failure of joint formation between the talus and calcaneus during hindfoot maturation. The patient in this case report has large bilateral os subtibiale and subtalar coalitions, which were undiagnosed throughout his soccer career until recently when he began having anteriorlateral ankle pain. After failing conservative treatment the patient underwent ankle arthroscopy, which revealed a fully separated, large articular portion of the medial malleolus. The hypertrophic synovium and cartilage were debrided and the patient had a full recovery, returning to soccer 8 weeks after surgery. Os subtibiale is a rare but well-described entity in the radiology and orthopaedic liturature. To our knowledge, bilateral os subtibiale this large has not been described. In addition, an os subtibiale with concomitant subtalar coalition has never been reported. This report will hopefully alert clinicians about these 2 rare anatomic findings and encourage them to use caution when evaluating suspected fractures of the medial malleolus that could be functional os subtibiale ossicles. In addition, we hope to shed some light on the complicated coupling of motion between the ankle and subtalar joint. These may have developed together to allow more normal coupled motion between the ankle and subtalar joint in this high-level college soccer player, and may be relevant to future reports or research in this area.
胫下骨是一块与正常胫骨远端内侧分离的附属骨。距下关节联合是后足成熟过程中距骨和跟骨之间关节形成失败的情况。本病例报告中的患者双侧有大的胫下骨和距下关节联合，在其整个足球生涯中一直未被诊断出来，直到最近他开始出现踝关节前外侧疼痛。保守治疗失败后，患者接受了踝关节镜检查，结果显示内踝有一个完全分离的大关节部分。对肥厚的滑膜和软骨进行了清创，患者完全康复，术后8周重返足球场。胫下骨在放射学和骨科学文献中是一种罕见但已有充分描述的实体。据我们所知，如此大的双侧胫下骨尚未见报道。此外，伴有距下关节联合的胫下骨从未有过报道。本报告有望提醒临床医生注意这两种罕见的解剖学发现，并鼓励他们在评估可能是功能性胫下骨小骨的内踝疑似骨折时谨慎行事。此外，我们希望能阐明踝关节和距下关节之间复杂的运动耦合关系。在这位高水平大学足球运动员中，这些结构可能共同发育，以允许踝关节和距下关节之间有更正常的耦合运动，这可能与该领域未来的报告或研究相关。
