Hitting the Slopes

A man hobbled into the emergency department complaining of continued ankle pain and increased swelling after falling from a ladder the day before. Ankle images were ordered. The mortis, syndesmosis, and malleoli appeared normal, but the massive medial soft tissue motivated a continued search. Was there something wrong with the lateral talus?The subsequent CT scan delineated a comminuted fracture of the talar lateral process extending to the subtalar joint — a snowboarder's fracture.Fractures of the lateral process of the talus are relatively uncommon, frequently missed, and can end up with long-term disability. It has been reported that 15 percent of ankle fractures are related to the lateral process, and missed diagnosis has been initially reported in 40-50 percent of cases. The mechanism of injury is inversion and dorsiflexion, causing the lateral process to be compressed between the distal fibula and the calcaneus. Snowboarders incur this injury approximately 15 times more frequently, and falls and motor vehicle crashes are also implicated in lateral talar process fractures.Tips to Remember<​ Maintain a high index of suspicion for a fracture of the lateral process of the talus with ankle sprains.<​ Consider a CT scan for better visualization of this region if there is concern.< Caution patients with suspected ankle sprains to seek re-evaluation if not improving as expected in the next one to two weeks.References"Imaging of Fractures of th...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs