Watanabe Hiroshi, Majima Tokifumi, Takahashi Kenji, Kawaji Hidemi, Takai Shinro
Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan.
Department of Orthopedic Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Japan.
J Foot Ankle Surg. 2017 Jan-Feb;56(1):187-190. doi: 10.1053/j.jfas.2016.02.001. Epub 2016 Mar 2.
We describe a rare case of a fracture of the medial tubercle of the posterior process of the talus in a 16-year-old male athlete who fell during basketball practice. The patient presented to our orthopedic clinic when pain and swelling had persisted despite 2 weeks of anti-inflammatory medication and rest. Computed tomography and magnetic resonance imaging scans revealed a fracture of the posteromedial tubercle of the talus and a small amount of retained fluid in the joint. Immobilization with a below-the-knee cast and non-weightbearing for 4 weeks, with a gradual return to full activity, was successful. At the 1-year follow-up evaluation, the patient expressed no complaints. Fracture of the posteromedial tubercle of the talus will usually result in a misdiagnosis or delayed diagnosis owing to the insidious onset of symptoms. We believe the present fracture configuration resulted from the vertical compression force that occurred on landing by posterior medial ankle impingement in plantarflexion-supination, modifying the conventional concept of the posteromedial tubercle fracture. We also present a suggested classification with a flowchart diagram.
我们描述了一例罕见的距骨后突内侧结节骨折病例，患者为一名16岁男性运动员，在篮球训练中摔倒。尽管经过了两周的抗炎药物治疗和休息，患者仍有疼痛和肿胀，遂前来我们的骨科诊所就诊。计算机断层扫描和磁共振成像扫描显示距骨后内侧结节骨折，关节内有少量积液。采用膝下石膏固定并4周不负重，然后逐渐恢复至完全活动，治疗成功。在1年的随访评估中，患者无任何不适主诉。距骨后内侧结节骨折通常会因症状隐匿而导致误诊或延迟诊断。我们认为，目前的骨折形态是由跖屈旋后位时后内侧踝关节撞击着地时产生的垂直压缩力所致，这改变了距骨后内侧结节骨折的传统概念。我们还通过流程图提出了一种建议的分类方法。
