Misdiagnosis of Talar Body or Neck Fractures as Ankle Sprains in Low Energy Traumas

Abstract

BackgroundThe 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.MethodsOf 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.ResultsIn 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).ConclusionsA 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.

Fractures of the Talus: Current Concepts

“…9,21,55 The true incidence of talar fractures may be underestimated because of a sensitivity of just 74% for plain radiographs, 14 and resultant prevalence of missed diagnosis. 9,61 Talar fractures are more common in men than women, and the average patient age early to mid-30s, with a broad range. 11,19,25,39,45,54 Fractures of the talar neck are the most common anatomic site for injury and account for 45% to 50% of all fractures of the talus.…”

“…14 CT should be part of routine surveillance of ankle injuries that have swelling and pain disproportionate to radiographic findings, as 6.9% of talus fractures were undiagnosed at the time of presentation. 61…”

“…1,21,51,52,60 The incidence of delayed presentation and/or undiagnosed injuries to the talar neck/body was found to be 6.9% in a review of 102 patients and most commonly occurred in lower-energy scenarios such as falls from 1 m, rotational injuries during the loading phase of rock climbing ascent, and rotational injuries during community ambulation. 61 Acute subtalar instability follows a similar pattern of injury mechanism for talar neck fractures, as it requires high energy to dislocate the inherently stable subtalar joint. 5 Talar head fractures, though rare, also represent a sequela of high-energy trauma, such as an MVC.…”

Closed Limb Fractures With Compromised Vascularization: A Narrative Review

“…7 Talar fractures may be missed on initial examination, being diagnosed as an ankle sprain. 36 Changes in gait will be observed and post-traumatic arthritis is another concern. 7,34 The talus comprises a neck, head, body, lateral process, and posterior process; not all regions of the talus are vascularly compromised.…”

Talar Body Reconstruction for Nonunions and Malunions

“…reported seven cases of talar body and neck fractures caused by minor injuries, such as tripping down the stairs and twisting the ankle when climbing that were misdiagnosed as ankle ligament injuries. 2 …”