Clin Orthop Surg.  2016 Sep;8(3):303-309. 10.4055/cios.2016.8.3.303.

Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

• Young KW
• Park YU
• Kim JS
• Cho HK
• Choo HS
• Park JH

• KMID: 2374277
• DOI: http://doi.org/10.4055/cios.2016.8.3.303

Abstract

BACKGROUND
The talus has a very complex anatomical morphology and is mainly fractured by a major force caused by a fall or a traffic accident. Therefore, a talus fracture is not common. However, many recent reports have shown that minor injuries, such as sprains and slips during sports activities, can induce a talar fracture especially in the lateral or posterior process. Still, fractures to the main parts of the talus (neck and body) after ankle sprains have not been reported as occult fractures.
METHODS
Of the total 102 cases from January 2005 to December 2012, 7 patients had confirmed cases of missed/delayed diagnosis of a talus body or neck fracture and were included in the study population. If available, medical records, X-rays, computed tomography scans, and magnetic resonance imaging of the confirmed cases were retrospectively reviewed and analyzed.
RESULTS
In the 7-patient population, there were 3 talar neck fractures and 4 talar body fractures (coronal shearing type). The mechanisms of injuries were all low energy trauma episodes. The causes of the injuries included twisting of the ankle during climbing (n = 2), jumping to the ground from a 1-m high wall (n = 2), and twisting of the ankle during daily activities (n = 3).
CONCLUSIONS
A talar body fracture and a talar neck fracture should be considered in the differential diagnosis of patients with acute and chronic ankle pain after a minor ankle injury.

Keyword

Sports; Trauma; Talus fracture; Ankle sprain

MeSH Terms

Adult
Ankle Fractures/*diagnosis/diagnostic imaging
Ankle Injuries/*diagnosis/diagnostic imaging
Diagnosis, Differential
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Radiography
Retrospective Studies
Sports
Talus/diagnostic imaging/*injuries
Young Adult

Figure

• 

  Fig. 1 (A) Frontal view of the ankle at initial presentation in the accident and emergency department. (B) Lateral view of the ankle at initial presentation in the accident and emergency department. (C, D) Frontal and lateral views of the ankle, showing a coronal shearing body fracture of the talus when the patient visited the clinic 5 months after the injury. (E) Sagittal magnetic resonance imaging demonstrating a coronal shearing body fracture of the talus accompanying avascular necrosis.

• 

  Fig. 2 Sagittal magnetic resonance imaging demonstrating a coronal shearing body fracture of the talus with a secondary arthritic change of the tibiotalar and subtalar joints.

• 

  Fig. 3 (A) Lateral view of the ankle, showing a coronal shearing talar body fracture with some displacement when the patient visited the clinic 3 months after the injury. (B) Sagittal magnetic resonance imaging demonstrating a coronal shearing body fracture of the talus with secondary arthritic change of the subtalar joint.

• 

  Fig. 4 Sagittal computed tomography demonstrating a coronal shearing body fracture of the talus with secondary arthritic change of the subtalar joint.

• 

  Fig. 5 Lateral view of the ankle, which shows a talar neck fracture with a malunion, when the patient visited the clinic 8 months after the injury.

• 

  Fig. 6 (A) Lateral view of the ankle, showing a minimally displaced talar neck fracture, 4 months after the injury. (B) Sagittal magnetic resonance imaging demonstrating a minimally displaced talar neck fracture.

• 

  Fig. 7 (A) Lateral view of the ankle at initial presentation in the accident and emergency department showing no abnormal findings. (B) Sagittal computed tomography demonstrating a minimally displaced talar neck fracture.

Reference

1. Dowling SK, Wishart I. Use of the Ottawa Ankle Rules in children: a survey of physicians' practice patterns. CJEM. 2011; 13(5):333–338.

2. Morris N, Lovell ME. Demographics of 3929 ankle injuries, seasonal variation in diagnosis and more fractures are diagnosed in winter. Injury. 2013; 44(7):998–1001.

3. Rogosić S, Bojanic I, Boric I, Tudor A, Srdoc D, Sestan B. Unrecognized fracture of the posteromedial process of the talus: a case report and review of literature. Acta Clin Croat. 2010; 49(3):315–320.

4. Santavirta S, Seitsalo S, Kiviluoto O, Myllynen P. Fractures of the talus. J Trauma. 1984; 24(11):986–989.

5. Shakked RJ, Tejwani NC. Surgical treatment of talus fractures. Orthop Clin North Am. 2013; 44(4):521–528.

6. Mukherjee SK, Pringle RM, Baxter AD. Fracture of the lateral process of the talus: a report of thirteen cases. J Bone Joint Surg Br. 1974; 56(2):263–273.

7. Nyska M, Howard CB, Matan Y, et al. Fracture of the posterior body of the talus: the hidden fracture. Arch Orthop Trauma Surg. 1998; 117(1-2):114–117.

8. Sharma S. Fracture of lateral process of the talus presenting as ankle pain. Emerg Med J. 2003; 20(1):E2.

9. Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970; 52(5):991–1002.

10. Sneppen O, Christensen SB, Krogsoe O, Lorentzen J. Fracture of the body of the talus. Acta Orthop Scand. 1977; 48(3):317–324.

11. Guillodo Y, Varache S, Saraux A. Value of ultrasonography for detecting ligament damage in athletes with chronic ankle instability compared to computed arthrotomography. Foot Ankle Spec. 2010; 3(6):331–334.

12. DIGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int. 2000; 21(10):809–815.

13. Higgins TF, Baumgaertner MR. Diagnosis and treatment of fractures of the talus: a comprehensive review of the literature. Foot Ankle Int. 1999; 20(9):595–605.

14. Juliano PJ, Dabbah M, Harris TG. Talar neck fractures. Foot Ankle Clin. 2004; 9(4):723–736.

15. Hawkins LG. Fracture of the lateral process of the talus. J Bone Joint Surg Am. 1965; 47(6):1170–1175.

16. Heckman JD, McLean MR. Fractures of the lateral process of the talus. Clin Orthop Relat Res. 1985; (199):108–113.

17. Chen CW, Hsu SY, Wei YS. Fracture of the medial tubercle of the posterior process of the talus. Formos J Musculoskelet Disord. 2011; 2(2):62–65.

18. Dougall TW, Ashcroft GP. Flexor hallucis longus tendon interposition in a fracture of the medial tubercle of the posterior process of the talus. Injury. 1997; 28(8):551–552.

19. Gutierres M, Cabral T, Miranda A, Almeida L. Fractures of the posteromedial process of the talus: a report of two cases. Int Orthop. 1998; 22(6):394–396.

20. Schenck RC Jr, Heckman JD. Fractures and dislocations of the forefoot: operative and nonoperative treatment. J Am Acad Orthop Surg. 1995; 3(2):70–78.

21. Judd DB, Kim DH. Foot fractures frequently misdiagnosed as ankle sprains. Am Fam Physician. 2002; 66(5):785–794.