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.
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

OBJECTIVE: To investigate a method to distinguish avulsion fracture from sesamoid, accessory bone, and permanent osteoepiphyte. METHODS: Fourteen cases of suspicious avulsion fractures of articular portion of tubular bones were reviewed. Direct/indirect signs and the injury mechanism of avulsion fractures were analyzed and compared with permanent osteoepiphyte, sesamoid and accessory bones for their morphological characteristics. RESULTS: There are two cases of permanent osteoepiphytes, three cases of sesamoids, and three cases of accessory bones. These cases were characterized by smooth edges, contiguous bony cortex, without swelling of the surrounding soft tissue or obvious image changes after consecutive radiography. CONCLUSION It is fundamental in image analysis to distinguish avulsion fracture from physiological small osteoepiphyte, sesamoid bone, and aberrant accessory bone.
Adolescent ; Adult ; Ankle Injuries/diagnostic imaging* ; Child ; Diagnosis, Differential ; Epiphyses/diagnostic imaging* ; Epiphyses, Slipped/diagnostic imaging* ; Female ; Forensic Medicine ; Fractures, Bone/diagnostic imaging* ; Humans ; Knee Injuries/diagnostic imaging* ; Male ; Middle Aged ; Retrospective Studies ; Sesamoid Bones/diagnostic imaging* ; Shoulder Fractures/diagnostic imaging* ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo analyze causes of missed diagnosis of hiding post-malleolar fractures in treating ankle joint fractures of pronation-external rotation type according to Lauge-Hansen classification and assess its medium-term outcomes.

METHODSAmong 103 patients with ankle joint fracture of pronation-external rotation type treated from March 2002 to June 2010,9 patients were missed diagnosis,including 6 males and 3 females,with a mean age of 35.2 years old (ranged, 18 to 55 years old) . Four patients were diagnosed during operation, 2 patients were diagnosed 2 or 3 days after first surgery and 3 patients came from other hospital. All the patients were treated remedially with lag screws and lock plates internal fixation. After operation,ankle joint function was evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS).

RESULTSAll the 9 patients were followed up, and the duration ranged from 14 to 30 months (averaged, 17 months). No incision infection was found, and all incision healed at the first stage. At the latest follow-up, AOFAS was 83.0 +/- 4.4, the score of 4 patients diagnosed during operation was 85.0 +/- 2.9, and the score of 5 patients treated by secondary operation was 81.0 +/- 5.3. All the patients got fracture union observed by X-ray at a mean time of 2.2 months after operation. There were no complications such as internal fixation loosing, broken and vascular or nerve injuries.

CONCLUSIONAnkle joint fracture of pronation-external rotation type may be combined with hiding post-malleolar fractures. So to patients with ankle joint fracture of pronation-external rotation type, lateral X-ray should be read carefully, and if necessary, CT or MRI examination should be performed. If adding lateral X-ray examination after reduction of exterior and interior ankle joint fixation, the missed diagnosis may be avoided.

Adolescent ; Adult ; Ankle Fractures ; False Negative Reactions ; Female ; Fractures, Bone ; diagnosis ; diagnostic imaging ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Pronation ; Rotation ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult