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Motley T. Rearfoot and Ankle Dislocations. Clin Podiatr Med Surg 2024; 41:551-569. [PMID: 38789170 DOI: 10.1016/j.cpm.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.
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Affiliation(s)
- Travis Motley
- Podiatry Surgical Residency, Department of Orthopaedic Surgery, Acclaim Multispecialty Group/John Peter Smith Hospital, 1500 South Main Street, 3rd Floor OPC, Fort Worth, TX, USA.
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Aamir J, Syziu A, Andritsos L, Caldwell R, Mason L. Tibialis posterior tendon entrapment in posterior malleolar and pilon injuries of the ankle: a retrospective analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:781-787. [PMID: 37698673 PMCID: PMC10858079 DOI: 10.1007/s00590-023-03714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND The Tibialis Posterior tendon (TPT) is the only tendon to encounter the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle, they often have been missed and present late. AIM Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia, i.e. Pilon (PLM) and posterior malleolar fractures (PMF). METHODS A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site, this was denoted as a minor entrapment and if ≥ 50% of the tendon was present in the fracture site was denoted as major. RESULTS A total of 363 patients were identified for further analysis, 220 who had a PMF and 143 with PLM injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture line entered the TPT sheath, there was a 45% rate (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath (p < .001). There was no significant difference in TPT entrapment in PMF as compared to PML (p = 0.353). CONCLUSION In our assessment, we found significant prevalence of 22% of TPT entrapment in fractures involving the posterior tibia. PMF and PLF had no statistically significant difference in the rate of TPT entrapment. Additionally, we found that there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider taking care assessing pre-operative imaging to seek to identify the TPT and to assess intraoperatively where entrapment does occur.
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Affiliation(s)
- Junaid Aamir
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Anxhela Syziu
- School and Medicine, University of Liverpool, Liverpool, UK
| | - Loukas Andritsos
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Robyn Caldwell
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Lyndon Mason
- Liverpool Orthopaedic Trauma Service, Liverpool University Hospital NHS Foundation Trust, Liverpool, UK.
- School and Medicine, University of Liverpool, Liverpool, UK.
- Department of Trauma and Orthopaedics, Aintree University Hospital, Liverpool, UK.
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Sendek G, Englar K, Huang BK, Hinchcliff KM. Diagnosis of a Rare Flexor Tendon Entrapment Using 3D CT Imaging Techniques. Hand (N Y) 2023; 18:NP1-NP4. [PMID: 37489114 PMCID: PMC10798195 DOI: 10.1177/15589447231185857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Flexor tendon entrapments as a result of fractures or dislocations in the upper extremity are rare. Diagnosis by clinical examination is not always possible, and imaging such as magnetic resonance imaging and ultrasound is often obtained. These modalities have the disadvantages of reduced sensitivity or increased cost and time, respectively. We present a unique case of a triquetral fracture and pisiform dislocation causing index finger flexor digitorum profundus (FDP-I) entrapment that was diagnosed preoperatively with computed tomography (CT) imaging with 3-dimensional (3D) volume rendering. A 30-year-old man presented in delayed fashion 4 weeks after a dune buggy accident. Among other injuries noted on examination, his index finger was held in flexion and unable to be passively extended. The CT source images showed dislocation and interposition of the FDP-I tendon within a fracture-dislocation of the triquetrum and pisiform. Postprocessed 3D volume renderings obtained from the CT source images confirmed this finding. The patient underwent operative intervention, where FDP-I entrapment between the triquetral fracture fragments and the dislocated pisiform was confirmed and released. Practitioners should be aware of this injury pattern and evolving advanced CT techniques which may be used to aid in soft-tissue diagnoses and obviate the need for additional advanced imaging.
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Vosoughi AR, Afaridi E, Solooki S, Shayan Z, Rammelt S. Prevalence and Predictors of Peroneal Tendon Instability Accompanying Calcaneal Fractures. Foot Ankle Int 2023; 44:825-833. [PMID: 37658714 DOI: 10.1177/10711007231175666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND We aimed to find the prevalence of peroneal tendon instability (PTI) accompanying different types of calcaneal fractures and to determine predictors of PTI based on preoperative CT scanning. METHODS In a retrospective cross-sectional study, preoperative CT scans of 400 consecutive calcaneal fractures undergoing surgery were reviewed for comminuted fragments in the lateral gutter of the ankle, fractures at the tip of the lateral malleolus, dislocated peroneal tendons, excessive displacement of the lateral calcaneal wall, calcaneal fracture-dislocation, superior peroneal retinaculum (SPR) avulsion fracture (fleck sign), and shape of the retromalleolar groove. The correlation of these variables with intraoperative SPR stress test, defined as the diagnostic criteria for PTI in calcaneal fractures, was evaluated. RESULTS In total, 369 patients (mean age, 39 ± 13; range, 11-72 years), with 321 (87.0%) of them male, were included. Among all calcaneal fractures, 67 cases (16.7%) had associated PTI as confirmed intraoperatively by an SPR stress test. A statistically significant association was found between PTI in calcaneal fractures and comminuted fragments in the lateral gutter of the ankle (P = .03), dislocated peroneal tendons (P < .001), calcaneal fracture-dislocation (P < .001), SPR avulsion fracture (P < .001), and Sanders type IV of calcaneal fracture (P = .02). There was no statistically significant relationship between PTI and the mechanism of injury (P = .98), side of fracture (P = .30), uni- or bilateral calcaneal fractures (P = .27), a fracture at the tip of lateral malleolus (P = .69), shape of the retromalleolar groove (P = .78), or excessive displacement of the lateral calcaneal wall (P = .06). The most specific CT finding to predict PTI accompanying calcaneal fractures was calcaneal fracture-dislocation (99.1%). CONCLUSION Following calcaneal fracture fixation, PTI was confirmed with intraoperative SPR stress test in one-sixth of cases. With the exception of calcaneal fracture-dislocation, preoperative findings on CT scanning and calcaneal fracture pathoanatomy are insufficient to diagnose PTI accompanying calcaneal fractures. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopaedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Afaridi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Solooki
- Bone and Joint Diseases Research Center, Department of Orthopaedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Community Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Stefan Rammelt
- University Center of Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany
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Vosoughi AR, Hashemipour B, Khademi S, Akbarzadeh A, Shayan Z. Clinical Outcomes Following Suturing of Sheath of Peroneal Tendons to the Calcaneal Plate as an Innovative Technique for Reduction of Peroneal Tendon Instability Accompanying Calcaneal Fracture. Foot Ankle Spec 2022:19386400221125373. [PMID: 36181273 DOI: 10.1177/19386400221125373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the clinical and functional outcomes following suturing of sheath of peroneal tendons to the calcaneal plate as an innovative technique for reduction of peroneal tendon instability (PTI) accompanying calcaneal fracture surgically treated via extensile lateral approach (ELA). METHODS In a retrospective comparative study, among 245 operatively treated calcaneal fractures through ELA, we had 33 cases with PTI who underwent relocation of the peroneal tendons with ethibond suture in a figure-of-8 shape, passed through 2 parts of sheath of peroneal tendons and stitched to the calcaneal plate. Of the 33 cases, 12 were evaluated in the experimental group. Twelve surgically treated calcaneal fractures without PTI were matched as the control group. The outcome of the patients was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI) percentage, Visual Analog Scale (VAS) pain, changes in Tegner activity level, maximal peroneal muscles strength testing, modified Star Excursion Balance Test (mSEBT), and triple hop for distance (THD) test. For the last 3 tests, the difference between operated and normal feet was calculated for each patient and this difference was compared between the 2 groups. RESULTS There was no statistically significant difference between the 2 groups for AOFAS Ankle-Hindfoot Scale (P = .09), FFI percentage (P = .12), VAS pain (P = .73), changes in Tegner activity level (P = .87), maximal peroneal muscles strength testing (P = .45), mSEBT (P > .05), and THD (P = .87) tests. We had a case with point tenderness on retromalleolar groove and 4 cases with paresthesia in the territory of the sural nerve in the experimental group in contrary to one case of sural nerve paresthesia in the control group (P = .31). CONCLUSIONS Relocation of peroneal tendons in PTI accompanying calcaneal fractures by fixing sheath of peroneal tendons to the calcaneal plate could be an acceptable procedure with good outcomes but may have increased chance of sural nerve injury. LEVELS OF EVIDENCE Therapeutic, Level III: Retrospective.
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Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hashemipour
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Khademi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Chi YL, Gao X, Xu YJ, Bu XM, Han L, Zhang X, Gao LF, Tian RH, Wang HB, Wu B. Open total dislocation of ankle joint without fractures: A case report. Medicine (Baltimore) 2021; 100:e26247. [PMID: 34087913 PMCID: PMC8183828 DOI: 10.1097/md.0000000000026247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/29/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Open total dislocation of ankle joint is rare and often caused by high-energy injury. The present study describes a patient with open total lateral dislocation of ankle joint without fractures and obtained a satisfactory clinical result following early debridement and irrigation, one-stage repairment of ligaments, and plaster external fixation. PATIENT CONCERNS The patient, a 45-year-old male, complained of right foot pain with bleeding and limited motion. Physical examination showed a 15-cm open wound at the medial ankle region, with soft tissues impaired and ankle bones exposed. The 3 dimensional reconstruction computed tomography (CT) examination showed an open total dislocation of ankle joint without concomitant fractures. DIAGNOSES open total lateral dislocation of ankle joint without fractures. INTERVENTIONS Early modern wound care including thorough debridement and irrigation on the wound was performed to remove contaminated soft tissues. Subsequently, the dislocated ankle joint was reduced by hand and the medial and lateral collateral ligaments were repaired using wire anchors. OUTCOMES The medial wound healed at 2 weeks after surgery, and several common complications such as infection and skin necrosis did not occur. The last follow-up showed a good range of metatarsal flexion and extension of the injured foot, and obvious signs of traumatic arthritis were not observed. According to Kaikkonen ankle function score, the patient was assessed with 90 points. LESSONS For open total dislocation of ankle joint, early treatment should focus on debridement and irrigation, reduction and fixation of the dislocated ankle, protection of the weak soft tissues, and stable external fixation to promote wound healing and reduce the incidence of related complications.
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Affiliation(s)
- Yu-lei Chi
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xu Gao
- Department of Qingdao Medical College, Qingdao University, Qingdao City
| | - Ying-jie Xu
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Xian-min Bu
- Department of Pathology, Jining No. 1 People's Hospital
| | - Liang Han
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China
| | - Xu Zhang
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China
| | - Long-fei Gao
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China
| | - Rong-hua Tian
- Department of Clinical Medicine, Jining Medical University, Jining City
| | - Hai-bin Wang
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China
| | - Bin Wu
- Department of Orthopedics, Affiliated Hospital of Jining Medical University, Jining City, Shandong Province, China
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Gorbachova T, Chang EY, Ha AS, Amini B, Dorfman SR, Fox MG, Khurana B, Klitzke A, Lee KS, Mooar PA, Shah KH, Shah NA, Singer AD, Smith SE, Taljanovic MS, Thomas JM, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Foot. J Am Coll Radiol 2020; 17:S2-S11. [PMID: 32370964 DOI: 10.1016/j.jacr.2020.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/26/2022]
Abstract
Acute injuries to the foot are frequently encountered in the emergency room and in general practice settings. This publication defines best practices for imaging evaluations for several variants of patients presenting with acute foot trauma. The variants include scenarios when the Ottawa rules can be evaluated, when there are exclusionary criteria, and when suspected pathology is in anatomic areas not addressed by the Ottawa rules. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | - Behrang Amini
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Alan Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Kaushal H Shah
- Icahn School of Medicine at Mt Sinai, New York, New York; American College of Emergency Physicians
| | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | | | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Nigh ED, Emerson CP, To D, Barnhill S, Rizzo MG, Nguyen DM, Ugarte A, Muñera F, Greif DN, Jose J, Dodds SD. Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures. J Wrist Surg 2020; 9:129-135. [PMID: 32257614 PMCID: PMC7113006 DOI: 10.1055/s-0039-3402424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls ( n = 7), motor vehicle accidents ( n = 6), dog bites ( n = 2), and gunshot wound ( n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis ( n = 1), extensor carpi ulnaris ( n = 1), extensor carpi radialis longus ( n = 1), and extensor digitorum communis ( n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.
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Affiliation(s)
- Evan D. Nigh
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christopher P. Emerson
- Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida
| | - David To
- Department of Radiology, Jackson Memorial Hospital, Miami, Florida
| | - Spencer Barnhill
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Michael G. Rizzo
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Duc M. Nguyen
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Ane Ugarte
- Department of Radiology, Hospital Universitario Donostia, San Sebastian, Spain
| | - Felipe Muñera
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Dylan N. Greif
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Jean Jose
- Department of Radiology, Jackson Memorial Hospital, Miami, Florida
| | - Seth D. Dodds
- Department of Orthopaedic Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
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Singer AD, Huynh T, Wong P, Sharma GB, Gonzalez F, Umpierrez M, Schenker ML, Moore TJ. CT can stratify patients as low risk for tibial neuropathy following a talus fracture. Emerg Radiol 2019; 26:541-548. [PMID: 31286323 DOI: 10.1007/s10140-019-01706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Determine the incidence of tibial neuropathy following talus fractures and CT's ability to stratify patients at risk for developing post-traumatic neuropathy. MATERIALS AND METHODS In this IRB-approved retrospective analysis, 71 talus fractures and 8 contralateral control ankle CTs were reviewed by one observer blinded to clinical information. CT evidence suggestive of tibial neurovascular bundle injury included nerve displacement, perineural fat effacement/edema, and bone touching nerve. The association between these CT findings and clinically evident tibial neuropathy was analyzed. A semi-quantitative likelihood score was assigned based on the degree of the CT findings around the nerve. Interobserver agreement was calculated between 2 other readers. RESULTS Twenty-five percent of patients in this cohort had clinical evidence of tibial neuropathy. There was a high specificity (0.87-0.93) and negative predictive value (0.83-0.87), a moderate accuracy (0.80-0.82), but a lower sensitivity (0.33-0.56) associated with the CT findings. Among the CT findings, nerve displacement (p < 0.0001) and bone touching nerve (p = 0.01) were associated with tibial neuropathy. A likelihood score of 2-5 was associated (p = 0.007-0.015) with tibial neuropathy. The presence of tibial neuropathy and nerve recovery were not associated with hospital length of stay, while CT findings were. There was substantial agreement between the three readers: likelihood scores 2+ (k = 0.78) and 3+ (k = 0.72). CONCLUSIONS Tibial neuropathy occurs following talus fractures, and CT findings may help surgeons narrow down the number of patients requiring close neurological follow-up.
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Affiliation(s)
- Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| | - Tony Huynh
- School of Medicine, Augusta State University, Augusta, GA, USA
| | - Phil Wong
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | | | - Felix Gonzalez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Mara L Schenker
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Thomas J Moore
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
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White EA, Skalski MR, Matcuk GR, Heckmann N, Tomasian A, Gross JS, Patel DB. Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. Emerg Radiol 2018; 26:67-74. [DOI: 10.1007/s10140-018-1629-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
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11
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Bae BJY, Baker JF, Orec RJ, Hadlow AT. Open Ankle Dislocation Without Fractures With Tibialis Posterior Tendon Interposition Through the Interosseous Space. J Foot Ankle Surg 2018; 56:1109-1113. [PMID: 28558998 DOI: 10.1053/j.jfas.2017.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Indexed: 02/03/2023]
Abstract
Open ankle dislocations without fracture are rare injuries. Dislocation or interposition of adjacent tendons are a rare associated feature of ankle fracture-dislocation. We report an extremely unusual case of open ankle dislocation without fracture with concurrent tibialis posterior tendon interposition through the interosseous space that was detected incidentally on computed tomography. We highlight the clinical, radiologic, and intraoperative features to avoid missing similar diagnoses.
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Affiliation(s)
- Bryan J Y Bae
- Junior Registrar, Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand.
| | - Joseph F Baker
- Orthopaedic Surgeon, Department of Orthopaedics, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Orec
- Orthopaedic Surgeon, Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | - Alastair T Hadlow
- Orthopaedic Surgeon, Department of Orthopaedics, Auckland City Hospital, Auckland, New Zealand
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12
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Galluzzo M, Greco F, Pietragalla M, De Renzis A, Carbone M, Zappia M, Maggialetti N, D'andrea A, Caracchini G, Miele V. Calcaneal fractures: radiological and CT evaluation and classification systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:138-150. [PMID: 29350643 PMCID: PMC6179077 DOI: 10.23750/abm.v89i1-s.7017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/31/2022]
Abstract
Background and aim of the work: The calcaneus, the more lower bone of the body, has the task of supporting the axial load from the weight of the body. Calcaneal fractures represent about 1-2% of all fractures and 60% of the tarsal bones fractures. The articular involvement has been associated with a poor functional outcome. The aim of this work is to describe the radiologic evaluation, the classification systems, the morphological preoperative diagnostic imaging features of calcaneal fractures, highlighting the correlation with the choice of treatment and predictive capacity for the fracture surgical outcome. Methods: A PubMed search was performed for the terms Imaging calcaneus fracture, selecting articles in English language, published in the last two years, where preoperatively diagnostic imaging of fractures of the calcaneus are described. Case reports have not been included. Results: We have collected a number of data that provide important help in preoperative evaluation of calcaneal fractures, such as the new classification system created by Harnroongroj et al, the association of calcaneal fractures with fractures of other bone structures or soft tissue impairment, the use of calcaneotalar ratio in assessing the length of heel. Conclusions: These data suggest an approach geared to the specific choice of treatment and to improving patient outcomes. (www.actabiomedica.it)
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