Clinical Images: Gouty Tophus as an Unusual Cause of Talus Fracture

Thomson, Steven; Urbanski, Stefan J.; MacMullan, Paul

doi:10.1002/art.40103

Cited by 1 publication

(1 citation statement)

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“…The present case was an 18-year-old male with a severe talus osteochondral lesion caused by gout tophus, which may have developed due to his bad dietary habit; he told us that he had an extreme liking for seafood, beer and carbonated drinks, all known risk factors for gout [7,8]. In the literature, we found a similar report on gout tophus as an unusual cause of talus fracture, but this was a 41-yearold man with a 20-year history of untreated gout, and pathological talus fracture-like neoplastic bone destruction was also reported [9], whereas in the present case the cyst lesion was well defined. We also found a remarkably similar report on gout tophus as an unusual cause of talus osteochondral lesion in a 16-year-old male who complained of fluctuating ankle pain on the anteromedial side, which was successfully managed with arthroscopic debridement and microfracture [10].…”

Section: Discussionmentioning

confidence: 63%

Gouty tophus as a rare cause of a Hepple stage V osteochondral lesion of the talus

Tang

Fan

2021

Eur J Med Res

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Background Talus osteochondral lesion is commonly associated with trauma, avascular necrosis or even genetic factors, but gouty tophus as a cause of Hepple stage V type talus osteochondral lesion is rare. Case presentation Here, we report a case of an 18-year-old man who complained of left medial deep ankle pain on ambulation. This young man had an extreme liking of sea food rich in purines and also sugar-sweetened drinks. He was diagnosed with a Hepple stage V type talus osteochondral lesion and was treated with medial malleolus osteotomy and an osteochondral graft. The talus osteochondral lesion was found to be a gouty tophus and was completely removed. Hypouricemic therapy was prescribed for 2 months, which allowed the patient to walk with a visual analogue score (VAS) score of 1. He was followed up for 12 months. Conclusions Young people with an extreme liking of sea food rich in purines and also sugar-sweetened drinks may be at a risk of developing gout. Acute onset of ankle atraumatic pain, swelling with a high level of serum uric acid and a talus osteochondral lesion with cyst formation should make physicians consider a diagnosis of gout.

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