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january case - January 5, 2008 8:39:45 PM

Dr.Wagner

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20 year old college judo star is caught in an ankle lock. He hobbles off the mat and is taken into the training room. The ATC snaps this xray of the foot.

What is the diagnosis and what is the disposition?

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< Message edited by Dr.Wagner -- January 5, 2008 8:45:13 PM >

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RE: january case - January 6, 2008 12:24:36 AM

TexasOrtho

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I don't have a strong background in radiology here, but the anterior talus looks odd in this image. He was able to walk off the mat? Thanks for putting this up.

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RE: january case - January 6, 2008 12:29:53 AM

TexasOrtho

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Did some research: talar neck fx?

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RE: january case - January 6, 2008 12:47:07 AM

jma

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displaced talar neck fx? What was/is the treatment for such a fracture?

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RE: january case - January 6, 2008 3:46:07 AM

T_Thom

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I witnessed a couple of ortho residents in an ED try to use traction/dorsiflexion to reduce this type of fracture once under fluoroscopy.. It wasn't pretty. Looked a lot like a subtalar manipulation but with *lots* of drugs and *lots* of force. They couldn't get it, and the patient ended up having an ORIF early the next morning. The attending wasn't too pleased.

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RE: january case - January 6, 2008 10:05:09 PM

bonez

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fracture dislocation of the talus. Was there also a frature of the fibula (not shown)?

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RE: january case - January 10, 2008 1:39:57 AM

Dr.Wagner

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Yes this a fracture dislocation of the talus...surgical correction. Talus is fractured.

This is unlike the far far more common talo-crural dislocation due to a trimalleolar fracture. Talus not fractured.

< Message edited by Dr.Wagner -- January 10, 2008 1:45:33 AM >

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RE: january case - January 10, 2008 1:42:24 AM

Dr.Wagner

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Here I am relocating an ankle in the ER (trimalleolar fracture) an unstable ankle. It is gruesome and open.

I hope I do not offend.

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RE: january case - January 10, 2008 2:12:55 AM

jma

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Ouch! What caused that particular fracture? An MVA?

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RE: january case - January 10, 2008 4:14:07 AM

TexasOrtho

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quote:

dislocation of the talus...surgical correction. Talus is fractured.

Wow...that's a medial view of the left foot? That must have been one hell of a trauma.

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RE: january case - January 10, 2008 4:56:35 PM

Shill

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Wow. Did he keep his foot?

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RE: january case - January 10, 2008 9:12:31 PM

ehanso

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Wow, nice picture. What are the expected complications and recovery for an open fracture like this?

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RE: january case - January 11, 2008 2:05:22 AM

Dr.Wagner

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You can get a nice picture when you have a camera in one hand...a foot in the other.

Complications are similar to any open fracture: infection, vascular injury, poor healing etc.

I believe this was a car accident.

Treatment from the surgical perspective is to wash the joint, debride, fixate.

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RE: january case - January 12, 2008 1:51:28 PM

fapt

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i guess fx of talus...wow

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